Patient preferences for coronary CT angiography with stress perfusion, SPECT, or invasive coronary angiography

Anum Minhas, Marc Dewey, Andrea L. Vavere, Yutaka Tanami, Mohammad R. Ostovaneh, Michael Laule, Carlos E. Rochitte, Hiroyuki Niinuma, Klaus F. Kofoed, Jacob Geleijns, John Hoe, Marcus Y. Chen, Kakuya Kitagawa, Cesar Nomura, Melvin E. Clouse, Frank J. Rybicki, Swee Yaw Tan, Narinder Paul, Matthew Matheson, Christopher CoxMatthias Rief, Pia Maier, Sarah Feger, Michail Plotkin, Eva Schönenberger

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)340-348
Number of pages9
Issue number2
StatePublished - May 2019

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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