Patient Preferences for Coronary CT Angiography with Stress Perfusion, SPECT, or Invasive Coronary Angiography.
Anum MinhasMarc DeweyAndrea L VavereYutaka TanamiMohammad R OstovanehMichael LauleCarlos E RochitteHiroyuki NiinumaKlaus Fuglsang KofoedJacob GeleijnsJohn HoeMarcus Y ChenKakuya KitagawaCesar Higa NomuraMelvin E ClouseFrank J RybickiSwee Yaw TanNarinder S PaulMatthew MathesonChristopher CoxMatthias RiefPia MaierSarah FegerMichail PlotkinEva SchönenbergerPublished in: Radiology (2019)
Background Patient preference is pivotal for widespread adoption of tests in clinical practice. Patient preferences for invasive versus other noninvasive tests for coronary artery disease are not known. Purpose To compare patient acceptance and preferences for noninvasive and invasive cardiac imaging in North and South America, Asia, and Europe. Materials and Methods This was a prospective 16-center trial in 381 study participants undergoing coronary CT angiography with stress perfusion, SPECT, and invasive coronary angiography (ICA). Patient preferences were collected by using a previously validated questionnaire translated into eight languages. Responses were converted to ordinal scales and were modeled with generalized linear mixed models. Results In patients in whom at least one test was associated with pain, CT and SPECT showed reduced median pain levels, reported on 0-100 visual analog scales, from 20 for ICA (interquartile range [IQR], 4-50) to 6 for CT (IQR, 0-27.5) and 5 for SPECT (IQR, 0-25) (P < .001). Patients from Asia reported significantly more pain than patients from other continents for ICA (median, 25; IQR, 10-50; P = .01), CT (median, 10; IQR, 0-30; P = .02), and SPECT (median, 7; IQR, 0-28; P = .03). Satisfaction with preparation differed by continent and test (P = .01), with patients from Asia reporting generally lower ratings. Patients from North America had greater percentages of "very high" or "high" satisfaction than patients from other continents for ICA (96% vs 82%, respectively; P < .001) and SPECT (95% vs 79%, respectively; P = .04) but not for CT (89% vs 86%, respectively; P = .70). Among all patients, CT was preferred by 54% of patients, compared with 18% for SPECT and 28% for ICA (P < .001). Conclusion For cardiac imaging, patients generally favored CT angiography with stress perfusion, while study participants from Asia generally reported lowest satisfaction. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Woodard and Nguyen in this issue.
Keyphrases
- end stage renal disease
- ejection fraction
- newly diagnosed
- chronic kidney disease
- computed tomography
- coronary artery disease
- prognostic factors
- clinical trial
- healthcare
- emergency department
- type diabetes
- randomized controlled trial
- spinal cord injury
- heart failure
- clinical practice
- chronic pain
- mass spectrometry
- coronary artery
- patient reported outcomes
- acute coronary syndrome
- photodynamic therapy
- pet ct
- left ventricular
- pain management
- neuropathic pain
- patient reported
- stress induced