CITY — May 9, 2024 —
A new study highlights the potential of SPECT/CT MPI in guiding medical therapy for coronary artery disease (CAD) patients. Researchers assessed the impact of specific medications prescribed after SPECT/CT MPI on patient survival and found notable associations between certain treatments and reduced mortality. The findings emphasize a targeted approach to CAD treatment that will help to improve outcomes. Further investigations will be needed to confirm these promising findings.
SPECT/CT MPI: Tailoring Medical Therapy for coronary Artery Disease
A recent study indicates that SPECT/CT myocardial perfusion imaging (MPI) can definitely help identify coronary artery disease (CAD) patients who are more likely to benefit from specific medical treatments. This suggests a potential role for SPECT/CT MPI in guiding medical therapy for CAD, according to researchers.
The Promise of Personalized Medicine
SPECT/CT MPI is a widely used diagnostic tool for CAD, capable of detecting areas of reduced blood flow (ischemia) and coronary artery calcium (plaque). Prior research has shown its utility in identifying patients who may require revascularization rather then medical therapy alone. Though, the ability of SPECT/CT MPI to optimize medical therapy has remained an open question.
Did you know? Coronary artery calcium (CAC) scoring, frequently enough performed alongside SPECT/CT MPI, is a strong predictor of future cardiovascular events. It measures the amount of calcified plaque in the coronary arteries.
To explore this, researchers evaluated the associations of beta-blockers, angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARBS), and statins, prescribed within 180 days following SPECT/CT MPI, with survival in patients with suspected CAD.
Study Details and Key Findings
The study involved 7,802 patients with known CAD who underwent technetium-99m sestamibi SPECT/CT MPI between January 2015 and December 2021. The imaging protocols included both rest and stress components, with the majority (over 95%) using one-day protocols. Coronary artery calcium was assessed using CT attenuation correction.
During a median follow-up of 4.6 years, 1,265 (16.2%) patients died. Survivors were generally younger (median age of 65.5 vs. 73.2), included a higher proportion of female patients, and had fewer conventional cardiovascular risk factors.
A graphical abstract of the study
Journal of Nuclear Cardiology
- Beta-blockers:
Were not associated with mortality but were associated with lower mortality among patients with more ischemia on SPECT MPI (hazard ratio [HR], 0.94; p < 0.001).
- Statins:
Statin therapy was associated with reduced mortality when coronary artery calcium (CAC) was present and extensive on imaging (HR, 0.56; p < 0.001). When CAC was not assessed, there was no association between statin use and mortality (HR 1.16, p = 0.236).
- ACE/ARBs:
ACE/ARB prescription was also associated with reduced mortality when CAC was extensive (HR, 0.61; p < 0.001).
Implications for Clinical Practice
The study highlights the potential for SPECT/CT MPI to influence medical therapy and survival in patients evaluated for CAD. The findings also underscore the importance of comprehensive medical therapy for these patients.
Pro Tip: When interpreting SPECT/CT MPI results, consider both the extent of ischemia and the coronary artery calcium score. This combination provides a more complete picture of a patient’s cardiovascular risk.
Researchers suggest that coronary artery calcium burden by CT attenuation correction imaging could be used to identify the highest risk patients most likely to benefit from these medications.
our findings support the role of SPECT MPI in combination with coronary artery calcification assessed on CT attenuation images to personalize medical management of patients with suspected CAD to optimize clinical outcomes.
Researchers
