PT  - JOURNAL ARTICLE
AU  - Gyung-Min Park
AU  - Young-Hak Kim
AU  - Sung-Cheol Yun
AU  - Jung-Min Ahn
AU  - Hyo-In Choi
AU  - Jae-Hyung Roh
AU  - Pil Hyung Lee
AU  - Mineok Chang
AU  - Sang Gyu Lee
AU  - Min-Woo Jo
AU  - Duk-Woo Park
AU  - Soo-Jin Kang
AU  - Seung-Whan Lee
AU  - Cheol Whan Lee
AU  - Dae Hyuk Moon
AU  - Seong-Wook Park
AU  - Seung-Jung Park
TI  - Anatomic or Functional Evaluation as an Initial Test for Stable Coronary Artery Disease: A Propensity Score Analysis
AID  - 10.2967/jnumed.115.169318
DP  - 2016 Sep 01
TA  - Journal of Nuclear Medicine
PG  - 1364--1369
VI  - 57
IP  - 9
4099  - http://jnm.snmjournals.org/content/57/9/1364.short
4100  - http://jnm.snmjournals.org/content/57/9/1364.full
SO  - J Nucl Med2016 Sep 01; 57
AB  - Little data are available to compare the clinical implications of coronary angiography (CAG) or myocardial perfusion imaging (MPI) as an initial evaluation for stable coronary artery disease (CAD). Methods: From national health insurance claims data in South Korea, patients aged 18 y or older without a known history of CAD, who underwent CAG or MPI for the diagnosis of stable CAD between 2009 and 2013, were enrolled. Patients were divided into CAG (n = 117,134) and MPI (n = 19,932) groups. The primary endpoint, defined as a composite of all-cause death and myocardial infarction, was compared by a propensity score analysis between the 2 groups. Results: There was a significant increase (39%) in the annual rate of CAG from 23,985 in 2009–2010 to 33,373 in 2012–2013. However, a substantial reduction (41%) in the annual MPI rate was also noted from 6,389 in 2009–2010 to 3,790 in 2012–2013. During the follow-up period (median, 2.4 y; interquartile range, 1.5–3.5), coronary revascularization was more frequently performed in the CAG group (adjusted hazard ratio [aHR] of CAG, 24.15; 95% confidence interval [CI], 19.66–29.68; P < 0.001). However, the incidence of the primary endpoint was significantly higher in the CAG group (aHR, 1.26; 95% CI, 1.17–1.36; P < 0.001). The individual endpoints of death (aHR, 1.16; 95% CI, 1.06–1.25; P = 0.001) and myocardial infarction (aHR, 1.95; 95% CI, 1.60–2.36; P < 0.001) were also higher in the CAG group. Conclusion: As an initial diagnostic test in patients with stable CAD, MPI is associated with a better clinical outcomes than CAG.