BACKGROUND: The effectiveness of stress single photon emission computed tomography (SPECT) as a gatekeeper for coronary angiography has not been extensively investigated. The characteristics of patients referred for early angiography after a normal stress SPECT study have not been described. METHODS AND RESULTS: Over a 10-year period, 14,273 patients without documented coronary artery disease (CAD) underwent stress SPECT. Images were abnormal in 47% and normal in 53%. The overall survival rate at 15 years was 55% for patients with abnormal images versus 71% for those with normal images (P < .001). Early coronary angiography (< or =3 months) was performed in only 97 patients (1.3%) with normal SPECT studies versus 1,756 patients (26%) with abnormal SPECT studies (P < .001). Most patients with normal SPECT studies referred for early angiography (85%) had clinical, exercise, or scintigraphic findings worrisome for CAD. Two thirds of these highly selected patients with normal SPECT studies who underwent angiography did not have significant CAD; the remaining one third had primarily 1- and 2-vessel CAD. CONCLUSIONS: Stress SPECT is an effective gatekeeper for coronary angiography. The annual overall mortality rate for patients with normal images was 1.9%. Only 1.3% of patients with normal images were referred for early angiography.
BACKGROUND: The effectiveness of stress single photon emission computed tomography (SPECT) as a gatekeeper for coronary angiography has not been extensively investigated. The characteristics of patients referred for early angiography after a normal stress SPECT study have not been described. METHODS AND RESULTS: Over a 10-year period, 14,273 patients without documented coronary artery disease (CAD) underwent stress SPECT. Images were abnormal in 47% and normal in 53%. The overall survival rate at 15 years was 55% for patients with abnormal images versus 71% for those with normal images (P < .001). Early coronary angiography (< or =3 months) was performed in only 97 patients (1.3%) with normal SPECT studies versus 1,756 patients (26%) with abnormal SPECT studies (P < .001). Most patients with normal SPECT studies referred for early angiography (85%) had clinical, exercise, or scintigraphic findings worrisome for CAD. Two thirds of these highly selected patients with normal SPECT studies who underwent angiography did not have significant CAD; the remaining one third had primarily 1- and 2-vessel CAD. CONCLUSIONS: Stress SPECT is an effective gatekeeper for coronary angiography. The annual overall mortality rate for patients with normal images was 1.9%. Only 1.3% of patients with normal images were referred for early angiography.
Authors: L J Shaw; R Hachamovitch; D S Berman; T H Marwick; M S Lauer; G V Heller; A E Iskandrian; K L Kesler; M I Travin; H C Lewin; R C Hendel; S Borges-Neto; D D Miller Journal: J Am Coll Cardiol Date: 1999-03 Impact factor: 24.094
Authors: Rory Hachamovitch; Sean Hayes; John D Friedman; Ishac Cohen; Leslee J Shaw; Guido Germano; Daniel S Berman Journal: J Am Coll Cardiol Date: 2003-04-16 Impact factor: 24.094
Authors: R Hachamovitch; D S Berman; L J Shaw; H Kiat; I Cohen; J A Cabico; J Friedman; G A Diamond Journal: Circulation Date: 1998-02-17 Impact factor: 29.690
Authors: R Hachamovitch; D S Berman; H Kiat; I Cohen; H Lewin; A Amanullah; X Kang; J Friedman; G A Diamond Journal: Am J Cardiol Date: 1997-08-15 Impact factor: 2.778
Authors: D S Berman; R Hachamovitch; H Kiat; I Cohen; J A Cabico; F P Wang; J D Friedman; G Germano; K Van Train; G A Diamond Journal: J Am Coll Cardiol Date: 1995-09 Impact factor: 24.094
Authors: R Hachamovitch; D S Berman; H Kiat; N Bairey-Merz; I Cohen; J A Cabico; J D Friedman; G Germano; K F Van Train; G A Diamond Journal: J Am Coll Cardiol Date: 1995-11-15 Impact factor: 24.094
Authors: Edward D Nicol; James Stirrup; Eliana Reyes; Michael Roughton; Simon P G Padley; Michael B Rubens; S Richard Underwood Journal: J Nucl Cardiol Date: 2008-04-16 Impact factor: 5.952