Une stratégie combinée coroscanner-scintigraphie myocardique peut permettre de réduire avec sécurité le recours à la coronarographie chez les patients ayant un résultat équivoque à l’un des tests

ObjectivesCT-coronary angiography (CTCA) and myocardial perfusion scintigraphy (MPS) have both high negative predictive values in detecting coronary artery disease (CAD) but suboptimal predictive positive values, leading to unnecessary invasive coronary angiography (ICA) in case of equivocal findings. Combining these two tests may obviate their inherent limitations.Patients and methodsSixty-seven patients at mostly intermediate risk of CAD were subjected to either CTCA (45 patients) or MPS (22 patients) at first test, followed by the second test because of equivocal results of the first test. A discordant defect between the two tests was considered as false positive, hence likely to exclude CAD, and a concordant defect as true positive, likely to confirm CAD. All patients with concordant defects were referred to subsequent ICA. All patients with discordant defects (except for seven of them who underwent ICA too) were subjected to a mean follow-up of 730 ± 377 days.ResultsDiscordant findings between CTCA and MPS were found in 41 patients, from whose 7/7 had no significant stenosis at the invasive angiography and 34/34 had no major cardiac event during follow-up. Concordant findings were found in 26 patients. Invasive coronary angiography revealed significant stenoses in 14/26 patients; 9/14 of them needed revascularization.ConclusionA strategy combining CTCA and MPS may safely reduce referral to ICA in patients with equivocal findings at a single examination.