Rami Doukky1, Kathleen Hayes, Nathan Frogge, Gautam Balakrishnan, Venkata Satish Dontaraju, Maria O Rangel, Yasmeen Golzar, Enrique Garcia-Sayan, Robert C Hendel. 1. Division of Cardiology, Rush University Medical Center, Chicago, IL (R.D., K.H., N.F., M.O.R.); Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL (R.D., Y.G.); Department of Medicine, Iowa Methodist Medical Center, Des Moines (G.B.); Division of Hospitalist Medicine, Rockford Memorial Hospital, Rockford, IL (V.S.D.); Division of Cardiology, Mount Sinai Hospital, Chicago, IL (E.G.-S.); and Cardiovascular Division, University of Miami, Miller School of Medicine, Miami, FL (R.C.H.).
Abstract
BACKGROUND: Appropriate use criteria (AUC) have been developed to aid in the optimal use of single-photon emission computed tomography (SPECT)-myocardial perfusion imaging (MPI), a technique that is a mainstay of risk assessment for ischemic heart disease. The impact of appropriate use on the prognostic value of SPECT-MPI is unknown. METHODS AND RESULTS: A prospective cohort study of 1511 consecutive patients undergoing outpatient, community-based SPECT-MPI was conducted. Subjects were stratified on the basis of the 2009 AUC for SPECT-MPI into an appropriate or uncertain appropriateness group and an inappropriate group. Patients were prospectively followed up for 27±10 months for major adverse cardiac events of death, death or myocardial infarction, and cardiac death or myocardial infarction. In the entire cohort, the 167 subjects (11%) with an abnormal scan experienced significantly higher rates of major adverse cardiac events and coronary revascularization than those with normal MPI. Among the 823 subjects (54.5%) whose MPIs were classified as appropriate (779, 51.6%) or uncertain (44, 2.9%), an abnormal scan predicted a multifold increase in the rates of death (9.2% versus 2.6%; hazard ratio, 3.1; P=0.004), death or myocardial infarction (11.8% versus 3.3%; hazard ratio, 3.3; P=0.001), cardiac death or myocardial infarction (6.7% versus 1.7%; hazard ratio, 3.7; P=0.006), and revascularization (24.7% versus 2.7%; hazard ratio, 11.4; P<0.001). Among the 688 subjects (45.5%) with MPI classified as inappropriate, an abnormal MPI failed to predict major adverse cardiac events, although it was associated with a high revascularization rate. Furthermore, appropriate MPI use provided incremental prognostic value beyond myocardial perfusion and ejection fraction data. CONCLUSIONS: When performed for appropriate indications, SPECT-MPI continues to demonstrate high prognostic value. However, inappropriate use lacks effectiveness for risk stratification, further emphasizing the need for optimal patient selection for cardiac testing.
BACKGROUND: Appropriate use criteria (AUC) have been developed to aid in the optimal use of single-photon emission computed tomography (SPECT)-myocardial perfusion imaging (MPI), a technique that is a mainstay of risk assessment for ischemic heart disease. The impact of appropriate use on the prognostic value of SPECT-MPI is unknown. METHODS AND RESULTS: A prospective cohort study of 1511 consecutive patients undergoing outpatient, community-based SPECT-MPI was conducted. Subjects were stratified on the basis of the 2009 AUC for SPECT-MPI into an appropriate or uncertain appropriateness group and an inappropriate group. Patients were prospectively followed up for 27±10 months for major adverse cardiac events of death, death or myocardial infarction, and cardiac death or myocardial infarction. In the entire cohort, the 167 subjects (11%) with an abnormal scan experienced significantly higher rates of major adverse cardiac events and coronary revascularization than those with normal MPI. Among the 823 subjects (54.5%) whose MPIs were classified as appropriate (779, 51.6%) or uncertain (44, 2.9%), an abnormal scan predicted a multifold increase in the rates of death (9.2% versus 2.6%; hazard ratio, 3.1; P=0.004), death or myocardial infarction (11.8% versus 3.3%; hazard ratio, 3.3; P=0.001), cardiac death or myocardial infarction (6.7% versus 1.7%; hazard ratio, 3.7; P=0.006), and revascularization (24.7% versus 2.7%; hazard ratio, 11.4; P<0.001). Among the 688 subjects (45.5%) with MPI classified as inappropriate, an abnormal MPI failed to predict major adverse cardiac events, although it was associated with a high revascularization rate. Furthermore, appropriate MPI use provided incremental prognostic value beyond myocardial perfusion and ejection fraction data. CONCLUSIONS: When performed for appropriate indications, SPECT-MPI continues to demonstrate high prognostic value. However, inappropriate use lacks effectiveness for risk stratification, further emphasizing the need for optimal patient selection for cardiac testing.
Authors: Vasken Dilsizian; Henry Gewirtz; Nicholas Paivanas; Anastasia N Kitsiou; Fadi G Hage; Nathan E Crone; Ronald G Schwartz Journal: J Nucl Cardiol Date: 2015-05-15 Impact factor: 5.952
Authors: Siqin Ye; LeRoy E Rabbani; Christopher R Kelly; Maureen R Kelly; Matthew Lewis; Yehuda Paz; Clara L Peck; Shaline Rao; Sabahat Bokhari; Shepard D Weiner; Andrew J Einstein Journal: Circ Cardiovasc Qual Outcomes Date: 2015-01-06
Authors: G Medolago; C Marcassa; A Alkraisheh; R Campini; A Ghilardi; R Giubbini Journal: Eur J Nucl Med Mol Imaging Date: 2014-03-15 Impact factor: 9.236
Authors: David E Winchester; Ryan J Chauffe; Ryan Meral; Daniel Nguyen; Scott Ryals; Raman Dusaj; Leslee Shaw; Rebecca J Beyth Journal: J Nucl Cardiol Date: 2014-08-02 Impact factor: 5.952
Authors: Islam Y Elgendy; Ahmed Mahmoud; Jonathan J Shuster; Rami Doukky; David E Winchester Journal: J Nucl Cardiol Date: 2015-08-08 Impact factor: 5.952