PT - JOURNAL ARTICLE AU - Park, Gyung-Min AU - Kim, Young-Hak AU - Yun, Sung-Cheol AU - Ahn, Jung-Min AU - Choi, Hyo-In AU - Roh, Jae-Hyung AU - Lee, Pil Hyung AU - Chang, Mineok AU - Lee, Sang Gyu AU - Jo, Min-Woo AU - Park, Duk-Woo AU - Kang, Soo-Jin AU - Lee, Seung-Whan AU - Lee, Cheol Whan AU - Moon, Dae Hyuk AU - Park, Seong-Wook AU - Park, Seung-Jung 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.