The Choice of anatomical or functional imaging could depend on the importance of cardiovascular-risk factors (CV-RF) and coronary artery history (CO-AH) in patients requiring screening for myocardial ischemia.

In a real-world, Nancy Ischemia Registry aims to prospectively study the consequences and impact of the choice of anatomical or functional imaging test on the screening of myocardial ischemia according to the importance of CV-RF and CO-AH.

Between May 2021 and the end of December 2022, we prospectively included 2977 examinations carried out as part of the screening for myocardial ischemia. 1013 Coronary Calcium-Scores (C-CS) (CV-RF: +) (CO-AH: -), 1108 CT-Coronary Angiograms (CT-ANG) (CV-RF: ++) (CO-AH: -), 687 Stress Echo (CV-RF: +++) (CO-AH: +) and 169 Stress CMR (CV-RF: ++++) (CO-AH: ++) were performed. When there is suspicion of myocardial ischemia, coronary angiography was performed: C-CS>400, CT-ANG Stenosis>50%, Stress Echo>2 ischemic segments, Stress CMR>2 ischemic segments.

Coronary angiography was performed in 210 patients in the (C-CS) group (21% of exams), 210 patients in the (CT-ANG) group (19% of exams), 123 patients in the Stress Echo group (18% exams), and 59 patients in the Stress CMR group (35% of exams). In patients with at least one significant coronary lesion (≥70% or FFR≤0.80); coronary revascularization was performed in 110 patients (52%) in the C-CS group, 112 patients (53%) in the CT-ANG group, 64 patients (71%) in the Stress Echo group and 38 patients (64%) in the Stress CMR group.

Nancy ischemia registry could suggest an algorithm based on the importance of cardiovascular risk and coronary history to better target the use of multimodality imaging for the detection of myocardial ischemia.

In a real world, this algorithm facilitates the management of at-risk patients and increases the efficiency and quality of monitoring.