Predictive value of a positive stress single-photon emission computed tomography or stress cardiac magnetic resonance for ruling in obstructive coronary artery disease in a real-world setting
Randomized controlled trials comparing stress cardiac magnetic resonance (CMR) and single-photon emission computed tomography (SPECT) suggest similar diagnostic accuracy for detecting obstructive coronary artery disease (CAD). There are few data on whether this remains true in routine clinical pract...
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creator | Silva, Cláudia Lopes, Pedro Gonçalves, Mariana Ventosa, António Calqueiro, João Freitas, Pedro Guerreiro, Sara Brito, João Abecasis, João Raposo, Luís Saraiva, Carla de Araújo Gonçalves, Pedro Santos, Ana Teles, Rui Campante de Sousa Almeida, Manuel Ferreira, António Miguel |
description | Randomized controlled trials comparing stress cardiac magnetic resonance (CMR) and single-photon emission computed tomography (SPECT) suggest similar diagnostic accuracy for detecting obstructive coronary artery disease (CAD). There are few data on whether this remains true in routine clinical practice.
The aim of this study was to assess clinical and angiographic characteristics of patients undergoing invasive coronary angiography (ICA) after stress CMR or SPECT, and to compare their positive predictive value with published results from the CE-MARC trial.
In this retrospective tertiary-center analysis, we included 429 patients undergoing ICA after a positive stress CMR or positive SPECT performed within the previous 12 months. Obstructive CAD was defined as any coronary artery stenosis ≥50% in a vessel compatible with the ischemic territory on stress testing.
Of the total 429 patients, 356 (83%) were referred after a positive SPECT, and 73 (17%) after a positive stress CMR. Patients did not differ according to age, cardiovascular risk factors, previous revascularization or left ventricular dysfunction, but patients with SPECT were more frequently male (p=0.046). The prevalence of obstructive CAD was similar in patients with positive SPECT vs. positive stress CMR (76.1% vs. 80.8%, respectively, p=0.385). The positive predictive values of both techniques were similar to those reported in the CE-MARC trial.
In this tertiary center analysis, stress CMR and SPECT showed similar positive predictive values, comparable to those reported in the CE-MARC trial. This finding supports the emerging adoption of CMR in clinical practice for the diagnosis and management of CAD.
Os ensaios randomizados que compararam a ressonância magnética cardíaca de stress (RMC) e a cintigrafia de perfusão miocárdica (SPECT) sugerem acuidade diagnóstica semelhante na avaliação da doença arterial coronária obstrutiva (DAC). Existem poucos dados acerca da sua reprodutibilidade na prática clínica diária. O objetivo deste estudo foi avaliar as características clínicas e angiográficas dos doentes submetidos a coronariografia invasiva (CAT) após RMC ou SPECT e comparar o seu valor preditivo positivo com os resultados publicados no estudo CE-MARC.
Nesta análise retrospetiva de centro único, incluímos 429 doentes submetidos a CAT, após RMC positiva ou SPECT positiva, realizada nos últimos 12 meses. DAC obstrutiva foi definida como qualquer estenose superior ou igual a 50% num vaso compatível co |
doi_str_mv | 10.1016/j.repc.2023.01.026 |
format | Article |
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The aim of this study was to assess clinical and angiographic characteristics of patients undergoing invasive coronary angiography (ICA) after stress CMR or SPECT, and to compare their positive predictive value with published results from the CE-MARC trial.
In this retrospective tertiary-center analysis, we included 429 patients undergoing ICA after a positive stress CMR or positive SPECT performed within the previous 12 months. Obstructive CAD was defined as any coronary artery stenosis ≥50% in a vessel compatible with the ischemic territory on stress testing.
Of the total 429 patients, 356 (83%) were referred after a positive SPECT, and 73 (17%) after a positive stress CMR. Patients did not differ according to age, cardiovascular risk factors, previous revascularization or left ventricular dysfunction, but patients with SPECT were more frequently male (p=0.046). The prevalence of obstructive CAD was similar in patients with positive SPECT vs. positive stress CMR (76.1% vs. 80.8%, respectively, p=0.385). The positive predictive values of both techniques were similar to those reported in the CE-MARC trial.
In this tertiary center analysis, stress CMR and SPECT showed similar positive predictive values, comparable to those reported in the CE-MARC trial. This finding supports the emerging adoption of CMR in clinical practice for the diagnosis and management of CAD.
Os ensaios randomizados que compararam a ressonância magnética cardíaca de stress (RMC) e a cintigrafia de perfusão miocárdica (SPECT) sugerem acuidade diagnóstica semelhante na avaliação da doença arterial coronária obstrutiva (DAC). Existem poucos dados acerca da sua reprodutibilidade na prática clínica diária. O objetivo deste estudo foi avaliar as características clínicas e angiográficas dos doentes submetidos a coronariografia invasiva (CAT) após RMC ou SPECT e comparar o seu valor preditivo positivo com os resultados publicados no estudo CE-MARC.
Nesta análise retrospetiva de centro único, incluímos 429 doentes submetidos a CAT, após RMC positiva ou SPECT positiva, realizada nos últimos 12 meses. DAC obstrutiva foi definida como qualquer estenose superior ou igual a 50% num vaso compatível com o território isquémico.
Num total de 429 pacientes, 356 (83%) foram encaminhados após SPECT positiva e 73 (17%) após RMC positiva. Os doentes não diferiram quanto à idade, fatores de risco cardiovascular, revascularização prévia ou disfunção ventricular esquerda, mas a percentagem de doentes do sexo masculino foi maior no grupo referenciado após SPECT (p=0,046). A prevalência de DAC obstrutiva foi semelhante nos doentes referenciados após SPECT positiva versus RMC positiva (76,1% versus 80,8%, respetivamente, p=0,385). Os valores preditivos positivos de ambas as técnicas foram semelhantes aos reportados no estudo CE-MARC.
Nesta análise de centro terciário, a RMC de stress e a SPECT mostraram valores preditivos positivos semelhantes, comparáveis aos publicados no estudo CE-MARC. Estes dados apoiam a adoção emergente da RMC na prática clínica para o diagnóstico e tratamento da DAC.</description><identifier>ISSN: 0870-2551</identifier><identifier>EISSN: 2174-2030</identifier><identifier>DOI: 10.1016/j.repc.2023.01.026</identifier><identifier>PMID: 37257584</identifier><language>eng</language><publisher>Portugal: Elsevier España, S.L.U</publisher><subject>Cardiovascular magnetic resonance ; Cintigrafia de perfusão miocárdica ; Doença arterial coronária obstrutiva ; Obstructive coronary artery disease ; Positive predictive value ; Ressonância magnética cardíaca ; Single-photon emission computed tomography ; Valor preditivo positivo</subject><ispartof>Revista portuguesa de cardiologia, 2023-09, Vol.42 (9), p.787-793</ispartof><rights>2023 Sociedade Portuguesa de Cardiologia</rights><rights>Copyright © 2023 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-19571d3c3b7ba6ced3f528bf66c9ac71ac0ef9232931ea290690f3fafee04903</citedby><cites>FETCH-LOGICAL-c400t-19571d3c3b7ba6ced3f528bf66c9ac71ac0ef9232931ea290690f3fafee04903</cites><orcidid>0000-0003-3823-5641 ; 0000-0003-2126-5377 ; 0000-0001-5050-4416 ; 0000-0002-1623-7382 ; 0000-0001-5488-2713 ; 0000-0002-1536-7855 ; 0000-0001-9968-477X ; 0000-0002-4127-3828 ; 0000-0003-2179-4738 ; 0000-0003-4301-3090</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,865,27926,27927</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37257584$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Silva, Cláudia</creatorcontrib><creatorcontrib>Lopes, Pedro</creatorcontrib><creatorcontrib>Gonçalves, Mariana</creatorcontrib><creatorcontrib>Ventosa, António</creatorcontrib><creatorcontrib>Calqueiro, João</creatorcontrib><creatorcontrib>Freitas, Pedro</creatorcontrib><creatorcontrib>Guerreiro, Sara</creatorcontrib><creatorcontrib>Brito, João</creatorcontrib><creatorcontrib>Abecasis, João</creatorcontrib><creatorcontrib>Raposo, Luís</creatorcontrib><creatorcontrib>Saraiva, Carla</creatorcontrib><creatorcontrib>de Araújo Gonçalves, Pedro</creatorcontrib><creatorcontrib>Santos, Ana</creatorcontrib><creatorcontrib>Teles, Rui Campante</creatorcontrib><creatorcontrib>de Sousa Almeida, Manuel</creatorcontrib><creatorcontrib>Ferreira, António Miguel</creatorcontrib><title>Predictive value of a positive stress single-photon emission computed tomography or stress cardiac magnetic resonance for ruling in obstructive coronary artery disease in a real-world setting</title><title>Revista portuguesa de cardiologia</title><addtitle>Rev Port Cardiol</addtitle><description>Randomized controlled trials comparing stress cardiac magnetic resonance (CMR) and single-photon emission computed tomography (SPECT) suggest similar diagnostic accuracy for detecting obstructive coronary artery disease (CAD). There are few data on whether this remains true in routine clinical practice.
The aim of this study was to assess clinical and angiographic characteristics of patients undergoing invasive coronary angiography (ICA) after stress CMR or SPECT, and to compare their positive predictive value with published results from the CE-MARC trial.
In this retrospective tertiary-center analysis, we included 429 patients undergoing ICA after a positive stress CMR or positive SPECT performed within the previous 12 months. Obstructive CAD was defined as any coronary artery stenosis ≥50% in a vessel compatible with the ischemic territory on stress testing.
Of the total 429 patients, 356 (83%) were referred after a positive SPECT, and 73 (17%) after a positive stress CMR. Patients did not differ according to age, cardiovascular risk factors, previous revascularization or left ventricular dysfunction, but patients with SPECT were more frequently male (p=0.046). The prevalence of obstructive CAD was similar in patients with positive SPECT vs. positive stress CMR (76.1% vs. 80.8%, respectively, p=0.385). The positive predictive values of both techniques were similar to those reported in the CE-MARC trial.
In this tertiary center analysis, stress CMR and SPECT showed similar positive predictive values, comparable to those reported in the CE-MARC trial. This finding supports the emerging adoption of CMR in clinical practice for the diagnosis and management of CAD.
Os ensaios randomizados que compararam a ressonância magnética cardíaca de stress (RMC) e a cintigrafia de perfusão miocárdica (SPECT) sugerem acuidade diagnóstica semelhante na avaliação da doença arterial coronária obstrutiva (DAC). Existem poucos dados acerca da sua reprodutibilidade na prática clínica diária. O objetivo deste estudo foi avaliar as características clínicas e angiográficas dos doentes submetidos a coronariografia invasiva (CAT) após RMC ou SPECT e comparar o seu valor preditivo positivo com os resultados publicados no estudo CE-MARC.
Nesta análise retrospetiva de centro único, incluímos 429 doentes submetidos a CAT, após RMC positiva ou SPECT positiva, realizada nos últimos 12 meses. DAC obstrutiva foi definida como qualquer estenose superior ou igual a 50% num vaso compatível com o território isquémico.
Num total de 429 pacientes, 356 (83%) foram encaminhados após SPECT positiva e 73 (17%) após RMC positiva. Os doentes não diferiram quanto à idade, fatores de risco cardiovascular, revascularização prévia ou disfunção ventricular esquerda, mas a percentagem de doentes do sexo masculino foi maior no grupo referenciado após SPECT (p=0,046). A prevalência de DAC obstrutiva foi semelhante nos doentes referenciados após SPECT positiva versus RMC positiva (76,1% versus 80,8%, respetivamente, p=0,385). Os valores preditivos positivos de ambas as técnicas foram semelhantes aos reportados no estudo CE-MARC.
Nesta análise de centro terciário, a RMC de stress e a SPECT mostraram valores preditivos positivos semelhantes, comparáveis aos publicados no estudo CE-MARC. Estes dados apoiam a adoção emergente da RMC na prática clínica para o diagnóstico e tratamento da DAC.</description><subject>Cardiovascular magnetic resonance</subject><subject>Cintigrafia de perfusão miocárdica</subject><subject>Doença arterial coronária obstrutiva</subject><subject>Obstructive coronary artery disease</subject><subject>Positive predictive value</subject><subject>Ressonância magnética cardíaca</subject><subject>Single-photon emission computed tomography</subject><subject>Valor preditivo positivo</subject><issn>0870-2551</issn><issn>2174-2030</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kc9u3CAQxlHVqFmleYEcKo692Blg_Qeplypq2kiR2kPuCMOwYWUbF_BWebq8Wtlu0mO4DBr9vk8z8xFyxaBmwNrrfR1xMTUHLmpgNfD2Hdlw1m0rDgLekw30HVS8adg5uUxpD-W1wKRoP5Bz0fGma_rthjz_imi9yf6A9KDHFWlwVNMlJP-vl3LElGjy827EankMOcwUJ5-SLx8TpmXNaGkOU9hFvTw-0RBfRUZH67Whk97NmL2hpRtmPRukrlBxHYsr9TMNQ1GspyFMiIWJT1THjKVYn1AnPGK6GOix-hPiaGnCnIv8Izlzekx4-VIvyMPtt4ebH9X9z-93N1_vK7MFyBWTTcesMGLoBt0atMI1vB9c2xqpTce0AXSSCy4FQ80ltBKccNohwlaCuCCfT7ZLDL9XTFmVExgcRz1jWJPiPWetkBL6gvITamJIKaJTS_RT2UgxUMfo1F4do1PH6BQwVaIrok8v_uswof0veQ2qAF9OAJYlDx6jSsZjOaX1EU1WNvi3_P8CuI6wlA</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Silva, Cláudia</creator><creator>Lopes, Pedro</creator><creator>Gonçalves, Mariana</creator><creator>Ventosa, António</creator><creator>Calqueiro, João</creator><creator>Freitas, Pedro</creator><creator>Guerreiro, Sara</creator><creator>Brito, João</creator><creator>Abecasis, João</creator><creator>Raposo, Luís</creator><creator>Saraiva, Carla</creator><creator>de Araújo Gonçalves, Pedro</creator><creator>Santos, Ana</creator><creator>Teles, Rui Campante</creator><creator>de Sousa Almeida, Manuel</creator><creator>Ferreira, António Miguel</creator><general>Elsevier España, S.L.U</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3823-5641</orcidid><orcidid>https://orcid.org/0000-0003-2126-5377</orcidid><orcidid>https://orcid.org/0000-0001-5050-4416</orcidid><orcidid>https://orcid.org/0000-0002-1623-7382</orcidid><orcidid>https://orcid.org/0000-0001-5488-2713</orcidid><orcidid>https://orcid.org/0000-0002-1536-7855</orcidid><orcidid>https://orcid.org/0000-0001-9968-477X</orcidid><orcidid>https://orcid.org/0000-0002-4127-3828</orcidid><orcidid>https://orcid.org/0000-0003-2179-4738</orcidid><orcidid>https://orcid.org/0000-0003-4301-3090</orcidid></search><sort><creationdate>20230901</creationdate><title>Predictive value of a positive stress single-photon emission computed tomography or stress cardiac magnetic resonance for ruling in obstructive coronary artery disease in a real-world setting</title><author>Silva, Cláudia ; Lopes, Pedro ; Gonçalves, Mariana ; Ventosa, António ; Calqueiro, João ; Freitas, Pedro ; Guerreiro, Sara ; Brito, João ; Abecasis, João ; Raposo, Luís ; Saraiva, Carla ; de Araújo Gonçalves, Pedro ; Santos, Ana ; Teles, Rui Campante ; de Sousa Almeida, Manuel ; Ferreira, António Miguel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-19571d3c3b7ba6ced3f528bf66c9ac71ac0ef9232931ea290690f3fafee04903</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Cardiovascular magnetic resonance</topic><topic>Cintigrafia de perfusão miocárdica</topic><topic>Doença arterial coronária obstrutiva</topic><topic>Obstructive coronary artery disease</topic><topic>Positive predictive value</topic><topic>Ressonância magnética cardíaca</topic><topic>Single-photon emission computed tomography</topic><topic>Valor preditivo positivo</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Silva, Cláudia</creatorcontrib><creatorcontrib>Lopes, Pedro</creatorcontrib><creatorcontrib>Gonçalves, Mariana</creatorcontrib><creatorcontrib>Ventosa, António</creatorcontrib><creatorcontrib>Calqueiro, João</creatorcontrib><creatorcontrib>Freitas, Pedro</creatorcontrib><creatorcontrib>Guerreiro, Sara</creatorcontrib><creatorcontrib>Brito, João</creatorcontrib><creatorcontrib>Abecasis, João</creatorcontrib><creatorcontrib>Raposo, Luís</creatorcontrib><creatorcontrib>Saraiva, Carla</creatorcontrib><creatorcontrib>de Araújo Gonçalves, Pedro</creatorcontrib><creatorcontrib>Santos, Ana</creatorcontrib><creatorcontrib>Teles, Rui Campante</creatorcontrib><creatorcontrib>de Sousa Almeida, Manuel</creatorcontrib><creatorcontrib>Ferreira, António Miguel</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Revista portuguesa de cardiologia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Silva, Cláudia</au><au>Lopes, Pedro</au><au>Gonçalves, Mariana</au><au>Ventosa, António</au><au>Calqueiro, João</au><au>Freitas, Pedro</au><au>Guerreiro, Sara</au><au>Brito, João</au><au>Abecasis, João</au><au>Raposo, Luís</au><au>Saraiva, Carla</au><au>de Araújo Gonçalves, Pedro</au><au>Santos, Ana</au><au>Teles, Rui Campante</au><au>de Sousa Almeida, Manuel</au><au>Ferreira, António Miguel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictive value of a positive stress single-photon emission computed tomography or stress cardiac magnetic resonance for ruling in obstructive coronary artery disease in a real-world setting</atitle><jtitle>Revista portuguesa de cardiologia</jtitle><addtitle>Rev Port Cardiol</addtitle><date>2023-09-01</date><risdate>2023</risdate><volume>42</volume><issue>9</issue><spage>787</spage><epage>793</epage><pages>787-793</pages><issn>0870-2551</issn><eissn>2174-2030</eissn><abstract>Randomized controlled trials comparing stress cardiac magnetic resonance (CMR) and single-photon emission computed tomography (SPECT) suggest similar diagnostic accuracy for detecting obstructive coronary artery disease (CAD). There are few data on whether this remains true in routine clinical practice.
The aim of this study was to assess clinical and angiographic characteristics of patients undergoing invasive coronary angiography (ICA) after stress CMR or SPECT, and to compare their positive predictive value with published results from the CE-MARC trial.
In this retrospective tertiary-center analysis, we included 429 patients undergoing ICA after a positive stress CMR or positive SPECT performed within the previous 12 months. Obstructive CAD was defined as any coronary artery stenosis ≥50% in a vessel compatible with the ischemic territory on stress testing.
Of the total 429 patients, 356 (83%) were referred after a positive SPECT, and 73 (17%) after a positive stress CMR. Patients did not differ according to age, cardiovascular risk factors, previous revascularization or left ventricular dysfunction, but patients with SPECT were more frequently male (p=0.046). The prevalence of obstructive CAD was similar in patients with positive SPECT vs. positive stress CMR (76.1% vs. 80.8%, respectively, p=0.385). The positive predictive values of both techniques were similar to those reported in the CE-MARC trial.
In this tertiary center analysis, stress CMR and SPECT showed similar positive predictive values, comparable to those reported in the CE-MARC trial. This finding supports the emerging adoption of CMR in clinical practice for the diagnosis and management of CAD.
Os ensaios randomizados que compararam a ressonância magnética cardíaca de stress (RMC) e a cintigrafia de perfusão miocárdica (SPECT) sugerem acuidade diagnóstica semelhante na avaliação da doença arterial coronária obstrutiva (DAC). Existem poucos dados acerca da sua reprodutibilidade na prática clínica diária. O objetivo deste estudo foi avaliar as características clínicas e angiográficas dos doentes submetidos a coronariografia invasiva (CAT) após RMC ou SPECT e comparar o seu valor preditivo positivo com os resultados publicados no estudo CE-MARC.
Nesta análise retrospetiva de centro único, incluímos 429 doentes submetidos a CAT, após RMC positiva ou SPECT positiva, realizada nos últimos 12 meses. DAC obstrutiva foi definida como qualquer estenose superior ou igual a 50% num vaso compatível com o território isquémico.
Num total de 429 pacientes, 356 (83%) foram encaminhados após SPECT positiva e 73 (17%) após RMC positiva. Os doentes não diferiram quanto à idade, fatores de risco cardiovascular, revascularização prévia ou disfunção ventricular esquerda, mas a percentagem de doentes do sexo masculino foi maior no grupo referenciado após SPECT (p=0,046). A prevalência de DAC obstrutiva foi semelhante nos doentes referenciados após SPECT positiva versus RMC positiva (76,1% versus 80,8%, respetivamente, p=0,385). Os valores preditivos positivos de ambas as técnicas foram semelhantes aos reportados no estudo CE-MARC.
Nesta análise de centro terciário, a RMC de stress e a SPECT mostraram valores preditivos positivos semelhantes, comparáveis aos publicados no estudo CE-MARC. Estes dados apoiam a adoção emergente da RMC na prática clínica para o diagnóstico e tratamento da DAC.</abstract><cop>Portugal</cop><pub>Elsevier España, S.L.U</pub><pmid>37257584</pmid><doi>10.1016/j.repc.2023.01.026</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-3823-5641</orcidid><orcidid>https://orcid.org/0000-0003-2126-5377</orcidid><orcidid>https://orcid.org/0000-0001-5050-4416</orcidid><orcidid>https://orcid.org/0000-0002-1623-7382</orcidid><orcidid>https://orcid.org/0000-0001-5488-2713</orcidid><orcidid>https://orcid.org/0000-0002-1536-7855</orcidid><orcidid>https://orcid.org/0000-0001-9968-477X</orcidid><orcidid>https://orcid.org/0000-0002-4127-3828</orcidid><orcidid>https://orcid.org/0000-0003-2179-4738</orcidid><orcidid>https://orcid.org/0000-0003-4301-3090</orcidid><oa>free_for_read</oa></addata></record> |
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identifier | ISSN: 0870-2551 |
ispartof | Revista portuguesa de cardiologia, 2023-09, Vol.42 (9), p.787-793 |
issn | 0870-2551 2174-2030 |
language | eng |
recordid | cdi_proquest_miscellaneous_2821639908 |
source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
subjects | Cardiovascular magnetic resonance Cintigrafia de perfusão miocárdica Doença arterial coronária obstrutiva Obstructive coronary artery disease Positive predictive value Ressonância magnética cardíaca Single-photon emission computed tomography Valor preditivo positivo |
title | Predictive value of a positive stress single-photon emission computed tomography or stress cardiac magnetic resonance for ruling in obstructive coronary artery disease in a real-world setting |
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