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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)
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نویسنده
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Karthikeyan Ganesan ,Salobir Barbara Guzic ,Jug Borut ,Devasenapathy Niveditha ,Alexanderson Erick ,Vitola Joao ,Kraft Otakar ,Ozkan Elgin ,Sharma Saket ,Purohit Gaurav ,Novak Maja Dolenc ,Meave Aloha ,Trevethan Sergio ,Cerci Rodrigo ,Zier Sandra ,Gotthardtová Lucia ,Jonszta Tomáš ,Altin Timucin ,Soydal Cigdem ,Patel Chetan ,Gulati Gurpreet ,Paez Diana ,Dondi Maurizio ,Kashyap Ravi
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منبع
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journal of nuclear cardiology - 2017 - دوره : 24 - شماره : 2 - صفحه:507 -517
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چکیده
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To 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). in 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. we 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. in 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 registration: clinicaltrials.gov identification number nct01368770.
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کلیدواژه
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Myocardial perfusion imaging—SPECT ,computed tomography ,coronary artery disease
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آدرس
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All India Institute of Medical Sciences, Department of Cardiology, India, University Medical Centre Ljubljana, Department of Nuclear Medicine, Slovenia, University Medical Centre Ljubljana, Department of Vascular Medicine, Slovenia, Indian Institute of Public Health-Delhi, India, Ignacio Chávez National Institute of Cardiology, Department of Nuclear Medicine, Mexico, Quanta Diagnóstico & Terapia, Brazil, Faculty Hospital Ostrava, Department of Nuclear Medicine, Czech Republic, Ankara University Medical Faculty, Department of Nuclear Medicine, Turkey, Indian Institute of Public Health-Delhi, India, All India Institute of Medical Sciences, Department of Cardiology, India, University Medical Centre Ljubljana, Department of Nuclear Medicine, Slovenia, Ignacio Chávez National Institute of Cardiology, Department of Radiology, Mexico, Ignacio Chávez National Institute of Cardiology, Department of Nuclear Medicine, Mexico, Quanta Diagnóstico & Terapia, Brazil, Quanta Diagnóstico & Terapia, Brazil, Faculty Hospital Ostrava, Department of Cardiology, Czech Republic, Faculty Hospital Ostrava, Department of Radiology, Czech Republic, Ankara University Medical Faculty, Department of Cardiology, Turkey, Ankara University Medical Faculty, Department of Nuclear Medicine, Turkey, All India Institute of Medical Sciences, Department of Nuclear Medicine, India, All India Institute of Medical Sciences, Department of Cardiac Radiology, India, International Atomic Energy Agency, Division of Human Health, Department of Nuclear Sciences and Applications, Austria, International Atomic Energy Agency, Division of Human Health, Department of Nuclear Sciences and Applications, Austria, International Atomic Energy Agency, Division of Human Health, Department of Nuclear Sciences and Applications, Austria
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Authors
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