Stress computed tomography perfusion versus stress cardiac magnetic resonance for the management of suspected or known coronary artery disease: resources and outcomes impact (STRATEGY II Study)

Abstract Funding Acknowledgements Type of funding sources: None. Background Non-invasive techniques have evolved as "gatekeepers" to invasive coronary angiography (ICA) for symptomatic patients with suspected or known artery disease (CAD). Evaluation myocardial ischemia functional tests represents a milestone in CAD detection proved diagnostic and prognostic power. Coronary computed tomography (CCTA), non-invasive anatomical assessment, intrinsically lacks physiologic data categorize the downstream hemodynamic significance lesions. Stress CT perfusion (stress-CTP) is recently imaging modality able assess inducible defects. The aim this study compare resources outcomes Impact combined CCTA+stress-CTP versus stress cardiovascular magnetic resonance (stress-CMR) consecutive intermediate high pre-test likelihood previous history revascularization. Methods 624 risk revascularization referred our hospital clinically indicated stress-CMR were enrolled. Stress-CTP scans performed 223 using 256-row whole heart-coverage scanner, static protocol acquisition vasodilation induced by adenosine. 401 evaluated 1.5-T scanner after vasodilatation dipyridamole. Patient follow-up was at 1 year index test performance. Endpoints follow: 1) all cardiac events endpoint revascularization, non-fatal MI death; 2) hard death. Results Stress-CMR group showed lower age, higher prevalence male gender while CCTA+CTP family statin use. CCTA defined positive obstructive 62% addition CTP on top reduced number 46%. resulted 23% subjects. Patients who underwent more (29% 7%, p: 0.001) no differences found terms death between two strategies. According predefined endpoints, rate vs 8%, (0.4% 3%, 0.033), respectively. Stratifying baseline characteristics events, left ventricle volume strategy predicted only events. Conclusions use associated referral but protective trend compared usual lone evaluation.