Trial reportJournal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology2017
Functional compared to anatomical imaging in the initial evaluation of patients with suspected coronary artery disease: An international, multi-center, randomized controlled trial (IAEA-SPECT/CTA study).
Trial report in Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01368770 (Stress-rest Single Photon-Emission Computed Tomography), which is not on this map. Cited by 17 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Stress-rest Single Photon-Emission Computed Tomography(SPECT)Compared to Coronary Computed Tomographic Angiography in the Initial Evaluation of Patients With Suspected Coronary Artery Disease-A Pilot Randomized Controlled Trial
Who cites it
17 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Representation of Older Adults and Women in Randomized Trials of Noninvasive Imaging for Chest Pain.Circulation. Cardiovascular imaging · 2025Pooled it
- Update of the Brazilian Guideline on Nuclear Cardiology - 2020.Arquivos brasileiros de cardiologia · 2020Guideline
- Negative predictive value of stress myocardial perfusion imaging and coronary computed tomography angiography: A meta-analysis.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2018Pooled it
- Outcomes of non-invasive diagnostic modalities for the detection of coronary artery disease: network meta-analysis of diagnostic randomised controlled trials.BMJ (Clinical research ed.) · 2018Pooled it
- Comparison of mid- to long-term clinical outcomes between anatomical testing and usual care in patients with suspected coronary artery disease: A meta-analysis of randomized trials.Clinical cardiology · 2017Pooled it
- Combined strategy of upfront CTCA and optimal treatment for stable chest pain: rationale and design of the CLEAR-CAD trial.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2024Article
- Clinical Application of Myocardial Perfusion SPECT in Patients with Suspected or Known Coronary Artery Disease. What Role in the Multimodality Imaging Era?Reviews in cardiovascular medicine · 2023Review
- Current Concepts and Future Applications of Non-Invasive Functional and Anatomical Evaluation of Coronary Artery Disease.Life (Basel, Switzerland) · 2022Review
- Poor outcome among patients undergoing myocardial perfusion imaging with intermediate-zone troponin.Internal and emergency medicine · 2022Article
- Review
- Review of cardiovascular imaging in the Journal of Nuclear Cardiology in 2017. Part 2 of 2: Myocardial perfusion imaging.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2018Review
- Cardiac CT in the Emergency Department: Contrasting Evidence from Registries and Randomized Controlled Trials.Current cardiology reports · 2018Review
- Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2017. Part 1 of 2: Positron emission tomography, computed tomography, and magnetic resonance.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2018Review
- Non-invasive imaging in suspected coronary artery disease: Choosing the right test from the first time.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2017Article
- Functional versus anatomical approach in stable coronary artery disease patients: Perspective of low- and middle-income countries.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2017Article
- Statistical issues associated with terminating a clinical trial due to slow enrollment.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2017Article
- Evaluation of Noninvasive Diagnostic Techniques in Identifying Coronary Artery Disease: A Systematic Review.Heart views : the official journal of the Gulf Heart AssociationReview
Corrections and comments
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Authors and funding
24 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo test the hypothesis that, in the initial evaluation of patients with suspected coronary artery disease (CAD), stress myocardial perfusion imaging (MPI) would result in less downstream testing than coronary computed tomographic angiography (CCTA).
methodsIn this international, randomized trial, mildly symptomatic patients with an intermediate likelihood of having CAD, and asymptomatic patients at intermediate risk of cardiac events, underwent either initial stress-rest MPI or CCTA. The primary outcome was downstream noninvasive or invasive testing at 6 months. Secondary outcomes included cumulative effective radiation dose (ERD) and costs at 12 months.
resultsWe recruited 303 patients (151 MPI and 152 CTA) from 6 centers in 6 countries. The initial MPI was abnormal in 29% (41/143) and CCTA in 56% (79/141) of patients. Fewer patients undergoing initial stress-rest MPI had further downstream testing at 6 months (adjusted OR 0.51, 95% CI 0.28-0.91, P = 0.023). There was a small increase in the median cumulative ERD with MPI (9.6 vs. 8.8 mSv, P = 0.04), but no difference in costs between the two strategies at 12 months.
conclusionIn the management of patients with suspected CAD, a strategy of initial stress MPI is substantially less likely to require further downstream testing than initial testing with CCTA.
trial registrationclinicaltrials.gov identification number NCT01368770.
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