Acceptance of Combined Coronary CT Angiography and Myocardial CT Perfusion versus Conventional Coronary Angiography in Patients with Coronary Stents--Intraindividual Comparison

Matthias Rief, Sarah Feger, Peter Martus, Michael Laule, Marc Dewey, Eva Schönenberger, Matthias Rief, Sarah Feger, Peter Martus, Michael Laule, Marc Dewey, Eva Schönenberger

Abstract

Objectives: To evaluate how well patients with coronary stents accept combined coronary computed tomography angiography (CTA) and myocardial CT perfusion (CTP) compared with conventional coronary angiography (CCA).

Background: While combined CTA and CTP may improve diagnostic accuracy compared with CTA alone, patient acceptance of CTA/CTP remains to be defined.

Methods: A total of 90 patients with coronary stents prospectively underwent CTA/CTP (both with contrast agent, CTP with adenosine) and CCA as part of the CARS-320 study. In this group, an intraindividual comparison of patient acceptance of CTA, CTP, and CCA was performed.

Results: CTP was experienced to be significantly more painful than CTA (p<0.001) and was associated with a higher frequency of dyspnea (p<0.001). Comparison of CTA/CTP with CCA revealed no significant differences in terms of pain (p = 0.141) and comfort (p = 0.377). Concern before CTA/CTP and CCA and overall satisfaction were likewise not significantly different (p = 0.097 and p = 0.123, respectively). Nevertheless, about two thirds (n = 60, 68%) preferred CTA/CTP to CCA (p<0.001). Moreover, patients felt less helpless during CTA/CTP than during CCA (p = 0.026). Lack of invasiveness and absence of pain were the most frequently mentioned advantages of CTA/CTP over CCA in our patient population.

Conclusions: CCA and combined CTA/CTP are equally well accepted by patients; however, more patients prefer CTA/CTP. CTP was associated with more intense pain than CTA and more frequently caused dyspnea than CTA alone.

Trial registration: ClinicalTrials.gov NCT00967876.

Conflict of interest statement

Competing Interests: Institutional master research agreements exist with Siemens Medical Solutions, Philips Medical Systems, and Toshiba Medical Systems. The terms of these arrangements are managed by the legal department of Charité – Universitätsmedizin Berlin. The CARS-320 study was supported by grants from Bracco and the German Heart Foundation. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. There are no financial conflicts for the other authors.

Figures

Fig 1. CONSORT Flow Diagram.
Fig 1. CONSORT Flow Diagram.
Fig 2. Pain intensity.
Fig 2. Pain intensity.
Boxplot of pain intensities patients reported for CTA/CTP and CCA on the horizontal visual analogue scale (0–100mm) and corresponding intraindividual comparison between the 68 patients who experienced pain during at least one examination; n = 36 pain CCA> CTA/CTP; n = 24 pain CTA/CTP> CCA; n = 8 pain CTA/CTP = CCA; p = 0.121 using the chi-square test.
Fig 3. Patient preference.
Fig 3. Patient preference.
Patient preferences for the different tests; significant preference for CTA/CTP by using the chi-square test.

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