MYOCARDIAL perfusion imaging (MPI) is a widely used diagnostic tool for assessing coronary artery disease (CAD), often influencing subsequent clinical decisions, including medication prescriptions. While pharmacological treatments for CAD such as ACE inhibitors, beta-blockers, and statins are well-established, the extent to which the benefits of these therapies vary based on imaging findings has remained unclear. A recent study sheds light on this by linking medication use following MPI with survival outcomes, highlighting the potential of imaging to personalise treatment. A key finding was that patients prescribed ACE inhibitors or ARBs had significantly lower mortality.
This retrospective cohort study included 7,802 consecutive patients who underwent single-photon emission computed tomography (SPECT) MPI between January 2015 and December 2021 for suspected CAD. Researchers used multivariable Cox regression models to investigate the relationship between medical therapy and all-cause mortality, while also assessing whether this relationship differed according to imaging characteristics, including levels of myocardial ischaemia and the presence of coronary artery calcification.
The study population had a mean age of 66.1 years (±12.0) and was 49.2% male. Use of ACE inhibitors or ARBs was associated with a significant reduction in mortality (adjusted hazard ratio [aHR]: 0.79; 95% CI: 0.69–0.89; p<0.001). Overall, beta-blockers were not linked to improved survival (HR: 1.00; 95% CI: 0.88–1.13; p=0.995), but in patients with greater ischaemia, beta-blocker use was associated with better outcomes (HR: 0.94 per summed difference score point; 95% CI: 0.90–0.97; p<0.001). Statins were associated with improved survival in patients with coronary calcification (HR: 0.73; 95% CI: 0.57–0.92, p=0.009), but not in those without calcification (HR: 1.18; 95% CI: 0.92–1.51, p=0.200).
These results suggest that findings from MPI can inform more tailored prescribing strategies for CAD, reinforcing its role beyond diagnosis. In particular, ACE/ARB therapy may benefit a broad patient group, while beta-blockers and statins may be most effective when guided by imaging features such as ischaemia and calcification. Study limitations include its retrospective design and reliance on all-cause rather than cardiovascular-specific mortality. Nevertheless, the data support a more nuanced approach to medical therapy following MPI in routine clinical practice.
Reference
Hijazi W et al. Association of Medical Therapies with Survival According to SPECT MPI Findings. J Nucl Cardiol. 2025;DOI: 10.1016/j.nuclcard.2025.102229.
