The utilization of myocardial perfusion imaging prior to coronary angiography to improve outcomes and cost-effectiveness of patients with stable coronary artery disease: a comparative cohort study in China.

BACKGROUND

The incremental value of myocardial perfusion imaging (MPI) before coronary angiography (CAG) for suspected or known stable coronary artery disease (SCAD) has not been validated in China. This study investigated the necessity of MPI for these patients regarding improvements in cardiac outcomes and cost-effectiveness in China.

METHODS

The initial cohort comprised 7,437 patients with suspected or known SCAD between 2018 and 2019. After excluding patients with acute coronary syndrome, previous myocardial infarction (MI) and revascularization, enrolled patients were divided into the CAG group and the MPI group according to the initial strategy (CAG or MPI). Then, two groups were matched by propensity score. The cost, revascularization, MI, and all-cause mortality of patients were followed.

RESULTS

The MPI and CAG groups each included 130 patients after matching, with similar basic characteristics (P > 0.05). Significantly decreased cardiac events were observed in the MPI group compared to the CAG group (6 vs. 16, P < 0.05). Furthermore, the number of revascularization (5 vs. 12), MI (1 vs. 3), and all-cause mortality (0 vs. 1) in the MPI group was also lower. The Cox model showed that fewer patients in the MPI group had cardiac events (HR 0.27, 95% CI 0.10-0.71). Moreover, patients in the MPI group had fewer first-visit costs ($718 vs. $1389) and fewer downstream costs ($120 vs. $344) than those in the CAG group (P < 0.001).

CONCLUSIONS

Our findings suggest that an MPI-first strategy is associated with fewer cardiac events and lower costs compared with an initial CAG strategy.

TRIAL REGISTRATION: Not applicable. This study is a retrospective analysis.