Clinical value of cardiac hybrid SPECT/CTA imaging on management strategies in CAD

Objectives Cardiac hybrid imaging increases diagnostic confidence in coronary artery disease (CAD) and provides important comprehensive information to allow for timely and appropriate treatment. We aimed at assessing the potential value of cardiac hybrid imaging on the appropriate management strategy selection for CAD.

Methods 238 patients underwent two day stess/rest 99mTc-MIBI single-photo emission computed tomography (SPECT) and coronary computed tomography angiography (CCTA) on a separate scanner for evaluation of CAD . Hybrid SPECT and CCTA was performed prior to treatment. Patients were divided into three groups defined according to the findings by hybrid SPECT and CCTA: 1. matched stenosis on CCTA and corresponding ischemic myocardium on SPECT, 2. unmatched SPECT and CCTA findings and 3. normal SPECT and CCTA findings. Treatment decisions were made according to 4 categories;1.No therapy, 2. Optimal medical treatment (OMT), 3. Percutaneous Coronary Intervention (PCI) and 4. Coronary Artery Bypass Grafting (CABG). Follow-up was confined to the first 60 days after hybrid imaging.

Results Hybrid images revealed matched, unmatched, and normal findings in 66, 106 , and 66 patients. The Invasive Coronary Angiography (ICA) rate within 60 days was 65% (43/66), 9%(10/106) and 0%(0/66) [ In which revascularizaton rate was 51.5% (34/66) , 0% (0/106) and 0% (0/66) ] for matched, unmatched and normal findings, respectively.

Conclusions Cardiac hybrid imaging with SPECT and CTA can play a major role in clinical decision making.

Research Support This work was supported by the Capital Medical Development Scientific Research Fund 2007-3089 and the capital medical university affiliated Beijing anzhen hospital dean technology development fund 2010C01.