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Research ArticleClinical Investigations

Anatomic or Functional Evaluation as an Initial Test for Stable Coronary Artery Disease: A Propensity Score Analysis

Gyung-Min Park, Young-Hak Kim, Sung-Cheol Yun, Jung-Min Ahn, Hyo-In Choi, Jae-Hyung Roh, Pil Hyung Lee, Mineok Chang, Sang Gyu Lee, Min-Woo Jo, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Cheol Whan Lee, Dae Hyuk Moon, Seong-Wook Park and Seung-Jung Park
Journal of Nuclear Medicine September 2016, 57 (9) 1364-1369; DOI: https://doi.org/10.2967/jnumed.115.169318
Gyung-Min Park
1Department of Cardiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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Young-Hak Kim
2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sung-Cheol Yun
3Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Jung-Min Ahn
2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Hyo-In Choi
2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Jae-Hyung Roh
2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Pil Hyung Lee
2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Mineok Chang
2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sang Gyu Lee
4Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
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Min-Woo Jo
5Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; and
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Duk-Woo Park
2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Soo-Jin Kang
2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Seung-Whan Lee
2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Cheol Whan Lee
2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Dae Hyuk Moon
6Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Seong-Wook Park
2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Seung-Jung Park
2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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  • FIGURE 1.
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    FIGURE 1.

    Overview of study population. CCTA = coronary CT angiography; ECG = electrocardiogram.

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    FIGURE 2.

    Cumulative incidence rates for adjusted all-cause death with and without MI between CAG and MPI groups.

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    TABLE 1

    Characteristics of Patients with Stable CAD Undergoing Initial Diagnostic Evaluation with Either CAG or MPI

    Overall (n = 137,066)
    CharacteristicCAG (n = 117,134)MPI (n = 19,932)P
    Age (y)60.6 ± 12.161.7 ± 12.2<0.001
    Sex, male, n (%)63,912 (54.6)10,422 (52.3)<0.001
    No. of patients enrolled (%)<0.001
     July 2009 to June 201023,985 (20.5)6,389 (32.1)
     July 2010 to June 201128,193 (24.1)5,513 (27.7)
     July 2011 to June 201231,583 (27.0)4,240 (21.3)
     July 2012 to June 201333,373 (28.5)3,790 (19.0)
    No. of comorbid conditions (%)
     Diabetes23,380 (20.0)4,864 (24.4)<0.001
     Diabetes with chronic complications11,520 (9.8)2,115 (10.6)0.001
     Hyperlipidemia33,591 (28.7)6,995 (35.1)<0.001
     Hypertension52,629 (44.9)10,184 (51.1)<0.001
     Congestive heart failure6,844 (5.8)830 (4.2)<0.001
     Arrhythmia7,686 (6.6)1,492 (7.5)<0.001
     Valvular disease1,622 (1.4)269 (1.4)0.694
     Peripheral vascular disease13,869 (11.8)2,345 (11.8)0.761
     Cerebrovascular disease14,026 (12.0)2,522 (12.7)0.007
     Chronic pulmonary disease25,327 (21.6)4,076 (20.5)<0.001
     Moderate to severe liver disease416 (0.4)179 (0.9)<0.001
     Renal disease3,107 (2.7)991 (5.0)<0.001
     Cancer6,246 (5.3)2,993 (15.0)<0.001
     Rheumatic disease3,533 (3.0)817 (4.1)<0.001
     Charlson comorbidity index1.5 ± 1.82.0 ± 2.2<0.001
    • Data are expressed as n, with percentages in parentheses, and mean ± SD.

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    TABLE 2

    Patient and Hospital Characteristics of CAG and MPI in South Korea Between 2009 and 2013

    CharacteristicJuly 2009 to June 2010July 2010 to June 2011July 2011 to June 2012July 2012 to June 2013P
    CAG
     Age (y)60.0 ± 12.260.4 ± 12.160.9 ± 12.160.9 ± 12.1<0.001
     Age groups (y)<0.001
      <558,184 (34.1)9,162 (32.5)9,719 (30.8)10,301 (30.9)
      55–646,722 (28.0)8,048 (28.6)9,388 (29.7)9,825 (29.4)
      ≥659,079 (37.9)10,983 (39.0)12,476 (39.5)13,247 (39.7)
     Male sex (n)12,881 (53.7)15,259 (54.1)17,321 (54.8)18,451 (55.3)0.001
     No. of hospitals providing a procedure154157161174
     Procedure volume of a hospital, per year155.7 ± 174.3179.6 ± 189.7196.2 ± 188.7191.8 ± 182.90.047
    MPI
     Age (y)61.0 ± 12.261.5 ± 12.162.0 ± 12.362.9 ± 12.3<0.001
     Age groups (y)<0.001
      <551,910 (29.9)1,610 (29.2)1,153 (27.2)928 (24.5)
      55–641,704 (26.7)1,448 (26.3)1,171 (27.6)1,013 (26.7)
      ≥652,775 (43.4)2,455 (44.5)1,916 (45.2)1,849 (48.8)
     Male sex (n)3,237 (50.7)2,925 (53.1)2,298 (54.2)1,962 (51.8)0.002
     No. of hospitals providing a procedure59565454
     Procedure volume of a hospital, per year108.3 ± 499.798.4 ± 479.778.5 ± 365.270.2 ± 310.10.537
    • Data are expressed as n, with percentages in parentheses, and mean ± SD.

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    TABLE 3

    Clinical Outcomes in Crude and Adjusted with Inverse Probability Treatment Weight Methods in Patients Undergoing CAG or MPI

    Incidence rate*CAG compared with MPI
    Clinical outcomeMPI (95% CI)CAG (95% CI)Crude hazard ratio (95% CI)PAdjusted hazard ratio (95% CI)P
    Crude
     All-cause death15.28 (14.25–16.30)14.58 (14.13–15.02)0.90 (0.83–0.96)0.003
     MI2.35 (1.96–2.75)4.43 (4.19–4.68)1.75 (1.46–2.09)<0.001
     Coronary revascularization1.88 (1.53–2.24)59.13 (58.18–60.07)25.33 (20.96–30.60)<0.001
     All-cause death/MI17.20 (16.11–18.29)18.39 (17.89–18.89)1.00 (0.93–1.07)0.999
     All-cause death/MI/coronary revascularization18.95 (17.81–20.10)77.07 (75.98–78.17)3.42 (3.22–3.64)<0.001
    Adjusted with inverse probability of treatment weighting
     All-cause death12.87 (11.80–13.93)15.02 (14.53–15.52)1.16 (1.06–1.25)0.001
     MI2.26 (1.79–2.73)4.46 (4.20–4.71)1.95 (1.60–2.36)<0.001
     Coronary revascularization2.20 (1.65–2.76)58.00 (57.05–58.94)24.15 (19.66–29.68)<0.001
     All-cause death/MI14.79 (13.63–15.95)18.85 (18.30–19.40)1.26 (1.17–1.36)<0.001
     All-cause death/MI/coronary revascularization16.85 (15.56–18.14)76.42 (75.30–77.53)4.24 (3.96–4.54)<0.001
    • ↵* Incidence rate per 1,000 person-year.

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Journal of Nuclear Medicine: 57 (9)
Journal of Nuclear Medicine
Vol. 57, Issue 9
September 1, 2016
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Anatomic or Functional Evaluation as an Initial Test for Stable Coronary Artery Disease: A Propensity Score Analysis
Gyung-Min Park, Young-Hak Kim, Sung-Cheol Yun, Jung-Min Ahn, Hyo-In Choi, Jae-Hyung Roh, Pil Hyung Lee, Mineok Chang, Sang Gyu Lee, Min-Woo Jo, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Cheol Whan Lee, Dae Hyuk Moon, Seong-Wook Park, Seung-Jung Park
Journal of Nuclear Medicine Sep 2016, 57 (9) 1364-1369; DOI: 10.2967/jnumed.115.169318

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Anatomic or Functional Evaluation as an Initial Test for Stable Coronary Artery Disease: A Propensity Score Analysis
Gyung-Min Park, Young-Hak Kim, Sung-Cheol Yun, Jung-Min Ahn, Hyo-In Choi, Jae-Hyung Roh, Pil Hyung Lee, Mineok Chang, Sang Gyu Lee, Min-Woo Jo, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Cheol Whan Lee, Dae Hyuk Moon, Seong-Wook Park, Seung-Jung Park
Journal of Nuclear Medicine Sep 2016, 57 (9) 1364-1369; DOI: 10.2967/jnumed.115.169318
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