The STRATEGY Study (Stress Cardiac Magnetic Resonance Versus Computed Tomography Coronary Angiography for the Management of Symptomatic Revascularized Patients): Resources and Outcomes Impact

Circ Cardiovasc Imaging. 2016 Oct;9(10):e005171. doi: 10.1161/CIRCIMAGING.116.005171.

Abstract

Background: Computed tomography coronary angiography (cTCA) and stress cardiac magnetic resonance (stress-CMR) are suitable tools for diagnosing obstructive coronary artery disease in symptomatic patients with previous history of revascularization. However, performance appraisal of noninvasive tests must take in account the consequent diagnostic testing, invasive procedures, clinical outcomes, radiation exposure, and cumulative costs rather than their diagnostic accuracy only. We aimed to compare an anatomic (cTCA) versus a functional (stress-CMR) strategy in symptomatic patients with previous myocardial revascularization procedures.

Methods and results: Six hundred patients with chest pain and previous revascularization included in a prospective observational registry and evaluated by clinically indicated cTCA (n=300, mean age 68.2±9.7 years, male 255) or stress-CMR (n=300, mean age 67.6±9.7 years, male 263) were enrolled and followed-up in terms of subsequent noninvasive tests, invasive coronary angiography, revascularization procedures, cumulative effective radiation dose, major adverse cardiac events, defined as a composite end point of nonfatal myocardial infarction and cardiac death, and medical costs. The mean follow-up for cTCA and stress-CMR groups was similar (773.6±345 versus 752.8±291 days; P=0.21). Compared with stress-CMR, cTCA was associated with a higher rate of subsequent noninvasive tests (28% versus 17%; P=0.0009), invasive coronary angiography (31% versus 20%; P=0.0009), and revascularization procedures (24% versus 16%; P=0.007). Stress-CMR strategy was associated with a significant reduction of radiation exposure and cumulative costs (59% and 24%, respectively; P<0.001). Finally, patients undergoing stress-CMR showed a lower rate of major adverse cardiac events (5% versus 10%; P<0.010) and cost-effectiveness ratio (119.98±250.92 versus 218.12±298.45 Euro/y; P<0.001).

Conclusions: Compared with cTCA, stress-CMR is more cost-effective in symptomatic revascularized patients.

Keywords: computed tomography; coronary artery disease; cost; cost-effectiveness; magnetic resonance; outcome; radiation exposure; revascularization.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Aged
  • Cause of Death
  • Computed Tomography Angiography* / economics
  • Coronary Angiography / economics
  • Coronary Angiography / methods*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / economics
  • Coronary Artery Disease / physiopathology
  • Coronary Artery Disease / therapy*
  • Coronary Vessels / diagnostic imaging*
  • Coronary Vessels / physiopathology
  • Cost-Benefit Analysis
  • Female
  • Health Care Costs
  • Humans
  • Italy
  • Magnetic Resonance Imaging / economics
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Myocardial Revascularization* / adverse effects
  • Myocardial Revascularization* / economics
  • Myocardial Revascularization* / mortality
  • Predictive Value of Tests
  • Prospective Studies
  • Radiation Dosage
  • Radiation Exposure
  • Registries
  • Reproducibility of Results
  • Time Factors
  • Treatment Outcome
  • Vasodilator Agents / administration & dosage*
  • Vasodilator Agents / economics

Substances

  • Vasodilator Agents