SPECT versus planar 99mTc-sestamibi myocardial scintigraphy: comparison of accuracy and impact on patient management in chronic ischemic heart disease.

A head-to-head comparison between 99mTc-sestamibi SPECT and planar myocardial imaging using dipyridamole low-level exercise stress was performed for the assessment of coronary artery disease (CAD) and for the impact on patient management in 78 patients (pts) who underwent coronary arteriography. Overall sensitivity and specificity for detection of CAD were 82% and 82% for SPECT, and 78% and 73% for planar imaging, respectively (both NS). Compared to planar imaging the sensitivity of SPECT imaging was significantly higher for detecting left anterior descending (p = 0.02) and left circumflex (p = 0.03) coronary artery disease. In predicting distally located stenoses, SPECT was significantly superior to planar imaging for the left circumflex artery (p = 0.025). Concordance analysis of perfusion status showed agreement in 308 of 390 (79%) of coronary flow regions both with respect to the presence or absence of perfusion and to the reversibility or irreversibility of defects (kappa = 0.60, SE 0.04). Stress-induced perfusion defects were significantly more detected by SPECT than by planar imaging (p < 0.001). Based on SPECT findings 31 pts were proposed for revascularization compared to 30 pts based on planar imaging (NS). Overall there was agreement in 65 (83%) pts regarding treatment strategy. We conclude that in a head-to-head comparison SPECT provided improved diagnostic value compared with planar imaging. However, with respect to patient treatment, the superiority of SPECT was not always translated into improved patient management.