Abstract 13473: 3D Fusion Between SPECT Myocardial Perfusion Imaging and Invasive Coronary Angiography to Guide Revascularization in Patients With Stable Coronary Artery Disease

Objective: We evaluated the value of 3-dimensional (3D) fusion of SPECT myocardial perfusion imaging (MPI) with invasive coronary angiography (ICA) to guide revascularization.

Methods: A retrospective observational study of 621 patients who underwent SPECT MPI and ICA. Based on the location of perfusion defect and stenosis on ICA, patients were classified into matched, unmatched, or normal groups via 3D fusion. The concordance between treatments was defined as, matched if there was revascularization in concordance with 3D fusion recommendation or if patient did not require revascularization; otherwise, they were classified as discordant. Major adverse cardiac events (MACE) (cardiac death, myocardial infarction, unstable angina requiring hospitalization or ICA, and unplanned revascularization) after revascularization of lesion recommended by 3D fusion were compared with those that the patients actually received.

Results: Over a five-year follow-up period, 16% experienced MACE. Rates of MACE were 69% for matched findings, 22% for unmatched findings, 9% for normal findings (P<0.01). Among the 366 patients who had at least one vessel with a stenosis of >=50%, those whose treatments were concordant with the fusion had significantly better outcomes compared to those who were not (P<0.05), primarily observed in the intermediate stenosis group (stenosis: 50-79%) (P<0.01) (Fig. A). Further, in the intermediate stenosis patients, the revascularization ratio in the concordant group was significantly higher in the LCX (31.2% vs. 14.3%, P<0.01) than that in the discordant group. (Fig. B)

Conclusions: 3D fusion prior to coronary revascularization can guide coronary revascularization to improve outcomes, among patients with stable CAD patients and intermediate stenosis.