Downstream invasive coronary procedures following PET Versus SPECT myocardial perfusion imaging: a propensity-matched...

We performed a retrospective analysis using the TriNetX Research Network. Adults undergoing PET or SPECT MPI without prior coronary revascularization were identified. The primary endpoint was invasive coronary angiography (ICA) within 90 days, with percutaneous coronary intervention (PCI) as a secondary endpoint. Propensity score matching (1:1) was performed to adjust for baseline differences.

A total of 33,822 propensity-matched patients were included (PET n=16,911; SPECT n=16,911). At 90 days, ICA occurred less frequently after PET compared with SPECT (6.0% vs 6.8%; RR 0.89, 95% CI 0.82-0.97; p=0.005). Conversely, PCI was more frequent following PET (0.9% vs 0.4%; RR 2.00, 95% CI 1.51-2.65; p<0.001), indicating a higher angiography-to-PCI procedural yield. These findings were consistent across sex-based subgroups.

In a large real-world cohort, PET MPI was associated with fewer downstream invasive coronary angiograms and a higher procedural PCI yield compared with SPECT. These findings suggest that PET may improve selection of patients for invasive evaluation and enhance efficiency of downstream care.