Coronary CT Perfusion Reduces Unnecessary Angiography — Meta-Analysis Highlights Added Value over CCTA Alone

A new systematic review and meta-analysis published in European Radiology (March 7, 2025) evaluates the impact of stress CT perfusion (CTP) when added to coronary CT angiography (CCTA) in patients with suspected or known coronary artery disease. Across 7 studies with 3,587 patients—including two RCTs—the analysis compared outcomes for CCTA + CTP vs. CCTA alone.

Key findings:

  • No difference in major adverse cardiovascular events (MACE), myocardial infarction, or unplanned revascularization up to 2 years.
  • Significantly fewer invasive coronary angiographies (ICA) overall in the CTP group (OR 2.42 for CCTA alone; p < 0.00001).
  • More targeted revascularization: Patients in the CTP group had a higher rate of ICA followed by stent placement (OR 0.39; p = 0.001), suggesting more precise patient selection.

Clinical takeaway:
Adding CTP to CCTA does not change hard outcomes but improves decision-making: fewer unnecessary ICAs and a higher proportion of therapeutic procedures. This supports a functional-anatomic approach for optimized and individualized management of chest pain.

Read the full article: https://link.springer.com/article/10.1007/s00330-025-11459-7