Comprehensive Cardiac CT With Myocardial Perfusion Imaging Versus Functional Testing in Suspected Coronary Artery Disease The Multicenter, Randomized CRESCENT-II Trial

Marisa Lubbers*, Adriaan Coenen, Marcel Kofflard, Tobias Bruning, Bas Kietselaer, Tjebbe Galema, Marc Kock, Andre Niezen, Marco Das, Marco van Gent, Ewout-Jan van den Bos, Leon van Woerkens, Paul Musters, Suze Kooij, Fay Nous, Ricardo Budde, Miriam Hunink, Koen Nieman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

57 Citations (Web of Science)

Abstract

OBJECTIVES This study sought to assess the effectiveness, efficiency, and safety of a tiered, comprehensive cardiac computed tomography (CT) protocol in comparison with functional testing. BACKGROUND Although CT angiography accurately rules out coronary artery disease (CAD), incorporation of CT myocardial perfusion imaging as part of a tiered diagnostic approach could improve the clinical value and efficiency of cardiac CT in the diagnostic work-up of patients with angina pectoris. METHODS Between July 2013 and November 2015, 268 patients (mean age 58 years; 49% female) with stable angina (mean pre-test probability 54%) were prospectively randomized between cardiac CT and standard guideline-directed functional testing (95% exercise electrocardiography). The tiered cardiac CT protocol included a calcium scan, followed by CT angiography if calcium was detected. Patients with >= 50% stenosis on CT angiography underwent CT myocardial perfusion imaging. RESULTS By 6 months, the primary endpoint, the rate of invasive coronary angiograms without a European Society of Cardiology class I indication for revascularization, was lower in the CT group than in the functional testing group (2 of 130 [1.5%] vs. 10 of 138 [7.2%]; p = 0.035), whereas the proportion of invasive angiograms with a revascularization indication was higher (88% vs. 50%; p = 0.017). The median duration until the final diagnosis was 0 (0 of 0) days in the CT group and 0 (0 of 17) in the functional testing group (p < 0.001). Overall, 13% of patients randomized to CT required further testing, compared with 37% in the functional testing group (p < 0.001). The adverse event rate was similar (3% vs. 3%; p = 1.000), although the median cumulative radiation dose was higher for the CT group (3.1 mSv [interquartile range: 1.6 to 7.8] vs. 0 mSv [interquartile range: 0.0 to 7.1]; p < 0.001). CONCLUSIONS In patients with suspected stable CAD, a tiered cardiac CT protocol with dynamic perfusion imaging offers a fast and efficient alternative to functional testing. (Comprehensive Cardiac CT Versus Exercise Testing in Suspected Coronary Artery Disease 2 [CRESCENT2]; NCT02291484) (C) 2018 by the American College of Cardiology Foundation.
Original languageEnglish
Pages (from-to)1625-1636
Number of pages12
JournalJACC-Cardiovascular Imaging
Volume11
Issue number11
DOIs
Publication statusPublished - 1 Nov 2018

Keywords

  • coronary CT angiography
  • CT calcium scan
  • CT myocardial perfusion imaging
  • diagnostic testing
  • functional testing
  • stable angina
  • COMPUTED-TOMOGRAPHY ANGIOGRAPHY
  • FRACTIONAL FLOW RESERVE
  • AMERICAN-HEART-ASSOCIATION
  • EMERGENCY-DEPARTMENT
  • MAGNETIC-RESONANCE
  • CLINICAL-OUTCOMES
  • NUCLEAR-MEDICINE
  • CHEST-PAIN
  • BLOOD-FLOW
  • RADIOLOGY

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