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CT coronary angiography (CTCA) vs myocardial perfusion imaging (MPI) in cardiac chest pain evaluation in patients with diabetes and an intermediate probability of coronary artery disease (CAD)

Session Poster session I

Speaker Shaman Dolly

Congress : ICNC, Nuclear Cardiology & Cardiac CT 2019

  • Topic : imaging
  • Sub-topic : Cross-Modality and Multi-Modality Imaging Topics
  • Session type : Poster Session
  • FP Number : P163

Authors : S Dolly (Bradford,GB), S Moteea (Bradford,GB), C Preston (Bradford,GB), V Watson (Bradford,GB), S Bulugahapitiya (Bradford,GB)

Authors:
S Dolly1 , S Moteea1 , C Preston1 , V Watson1 , S Bulugahapitiya1 , 1Bradford Royal Infirmary, Cardiology - Bradford - United Kingdom of Great Britain & Northern Ireland ,

Citation:

Background & Introduction:

The 2016 update to the NICE guideline for the investigation of new onset stable chest pain recommends use of CTCA as first line investigation in intermediate risk patients.

Purpose:

To compare imaging modality (CTCA and MPI) in intermediate risk diabetic and non-diabetic patients.

Methods:

Retrospective review of patients referred to the rapid access chest pain clinic over a 12 month period. Individuals with intermediate risk and subsequent imaging utilised were determined. The diagnostic yield of CTCA and MPI in patients with diabetes was compared. Average Q-risk2 scores for population was calculated.

Results:

Total number of patients referred: 1376
Patients with intermediate risk: 545
Patients with diabetes: 163

Please see Table below

-Chi-squared analysis CTCA vs MPI in diabetics: Chi-squared statistic 4.87. p-value 0.03. Chi-Squared with Yates correction = 4.07 p-value 0.044

-5 of the 20 patients with positive CTCAs went on for angiography, with 3 proceeding to percutaneous coronary intervention (PCI), and 2 for coronary artery bypass grafting (CABG).  2 had further functional testing in the way of MPI.

-13 of the 35 patients with positive MPIs went on to angiography, with 7 proceeding to PCI, and 3 for CABG.

Conclusions:

-MPI is more useful than CTCA in excluding functionally significant CAD in intermediate risk patients with diabetes.

-From our study, it is not possible to comment on which imaging modality is the best gatekeeper for invasive coronary angiography.

Diabetes (163)

Average Q-risk2 - 29.4

Positive CTCA/TotalCTCA 20/42 (47%)
Positive MPI/Total MPI 35/121 (28%)

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