Abnormal myocardial perfusion in the absence of anatomically significant coronary artery disease: implications and clinical significance

Healthcare resource utilization among patients receiving non-invasive testing for coronary artery disease in an outpatient setting: A cohort study reflecting daily practice trends

BACKGROUND

Accurate, early diagnosis and the initiation of appropriate treatment is central to reducing the clinical burden of coronary artery disease (CAD); however, real-world evidence characterizing healthcare resource utilization (HCRU) associated with testing for CAD is lacking.

METHODS AND RESULTS

Using a non-interventional, retrospective, secondary database analysis, patients aged ≥18 years who underwent outpatient non-invasive cardiac diagnostic testing were identified. The primary objective was to gain an understanding of pre- and post-assessment care pathways and the associated interventions for patients who underwent non-invasive testing for CAD in either an outpatient or emergency department setting. Overall, chest pain was the primary reason for the index visit (54.8%), followed by shortness of breath (23.7%), myocardial infarction (MI), coronary artery disease (CAD) or congestive heart failure (CHF) (3.8%), and other (46.8%); 3.0% of patients had no apparent reason for testing in the last 45 days. Single-photon emission computed tomography (SPECT) was the dominant diagnostic testing modality (40.3%). During the 90-day follow-up, 7.3% (n = 22,083) of patients were diagnosed with CAD; among these patients, 19.4% had repeat diagnostic testing, 26.0% of patients had a revascularization procedure, and 65.6% underwent cardiac catheterization. These rates varied by testing modality.

CONCLUSIONS

In this study of a large real-world data sample, variability in the use of non-invasive tests and HCRU were evident. These results may assist efforts to optimize system-wide care/diagnostic pathways and value-based treatment decisions for patients.

Myocardial Perfusion SPECT Utility in Predicting Cardiovascular Events Among Indonesian Diabetic Patients

Background:

Indonesia has the fourth largest number of diabetes patients after India, China and the USA. Coronary artery disease (CAD) is the most common cause of death in diabetic patients. Early detection and risk stratification is important for optimal management. Abnormal myocardial perfusion imaging (MPI) is an early manifestation in the ischemic cascade. Previous studies have demonstrated the use of MPI to accurately diagnose obstructive CAD and predict adverse cardiac events. This study evaluated whether MPI predicts adverse cardiac event in an Indonesian diabetic population.

Method:

The study was undertaken in a consecutive cohort of patients with suspected or known CAD fulfilling entry criteria. All had adenosine stress MPI. The end point was a major adverse cardiac event (MACE) defined as cardiac death or nonfatal myocardial infarction (MI).

Results:

Inclusion and exclusion criteria were satisfied by 300 patients with a mean follow-up of 26.7 ± 8.8 months. The incidence of MACEs was 18.3% among diabetic patients, versus 9% in the non-diabetic population (p < 0.001). A multivariable Cox proportional hazard model demonstratedin dependent predictors for a MACE as abnormal MPI [HR: 9.30 (3.01 – 28.72), p < 0.001], post stress left ventricular ejection fraction (LVEF) ≤30% [HR:2.72 (1.21 – 6.15), p = 0.016] and the patients diabetic status [HR:2.28 (1.04 – 5.01), p = 0.04]. The Kaplan Meier event free survival curve constructed for the different subgroups based on the patients’ diabetic status and MPI findings demonstrated that diabetic patients with an abnormal MPI had the worst event free survival (log rank p value < 0.001).

Conclusions:

In an Indonesian population with suspected or known CAD abnormal adenosine stress MPI is an independent and potent predictor for adverse cardiovascular events and provides incremental prognostic value in cardiovascular risk stratification of patients with diabetes.