Impact Of Initial Myocardial Perfusion Imaging Versus Invasive Coronary Angiography On Costs And Clinical Outcomes In Stable Coronary Artery Disease

Objective:In patients with stable coronary artery disease(CAD),there are two main options for guiding treatment: initial invasive coronary angiography(CAG)or selective CAG after the risk stratification of myocardial perfusion imaging(MPI).Debate continues regarding whether patients with stable coronary artery disease(SCAD)might benefit from initial myocardial perfusion imaging(MPI)or coronary angiography(CAG).This study compares and analyses cost and clinical outcomes in the First Hospital of Shanxi Medical University regarding the two strategies.Methods:This study included 664 patients who presented to the hospital between January 2018 and end of December 2019 with suspected or known stable CAD,excluding patients with acute coronary syndrome,previous myocardial infarction(MI)or coronary revascularization.Patients were divided into two groups based on initial use of CAG or MPI,and each group was followed up to the end of 2022 for costs due to suspected or known stable CAD,and rates of myocardial revascularization,myocardial infarction and all-cause mortality.Univariate and multivariate COX proportional risk models were used to estimate the risk of events.Results:There were 332 patients in the MPI and CAG groups,respectively,with a similar Charlson comorbidity index(CCI).MPI strategy was on average 61% cheaper than CAG strategy(P<0.0001).The MPI group had a significantly and dramatically lower incidence of cardiac events(27 vs.92,P<0.0001)than the CAG group.Further,the incidence of revascularization(19 vs.60,P<0.0001),MI(6 vs.27,P<0.001),and all-cause mortality(2vs.5,P>0.05)was also lower in the MPI group than in the CAG group.Multivariable analysis adjusting for age,gender,CCI,and comorbidities showed that in the MPI group fewer patients had revascularization(HR 0.19,95% CI 0.12–0.31)and MI(HR 0.18,95%CI 0.07–0.45)than CAG group,and the rate of all-cause mortality was lower(HR 0.80,95%CI 0.12–5.58).Conclusion:In patients with suspected or stable CAD,this study showed that a diagnostic strategy guided by MPI could reduce costs and the incidence of cardiac events,resulting in savings in healthcare resources and health insurance funds.