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Abstract

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.

Author information

Park GM1, Kim YH2, Yun SC3, Ahn JM4, Choi HI4, Roh JH4, Lee PH4, Chang M4, Lee SG5, Jo MW6, Park DW4, Kang SJ4, Lee SW4, Lee CW4, Moon DH7, Park SW4, Park SJ4.​

1Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.

2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea mdyhkim@amc.seoul.kr.

3Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

4Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

5Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Korea.

6Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; and.

7Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.