Impact of appropriate use on the prognostic value of single-photon emission computed tomography myocardial perfusion imaging

Rami Doukky, Kathleen Hayes, Nathan Frogge, Gautam Balakrishnan, Venkata Satish Dontaraju, Maria O. Rangel, Yasmeen Golzar, Enrique Garcia-Sayan, Robert C. Hendel

Research output: Contribution to journalArticle

91 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1634-1643
Number of pages10
JournalCirculation
Volume128
Issue number15
DOIs
StatePublished - Oct 8 2013

Keywords

  • Myocardial perfusion imaging
  • Outcome assessment (health care)
  • Prognosis
  • Tomography, emission-computed, single-photon

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

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    Doukky, R., Hayes, K., Frogge, N., Balakrishnan, G., Dontaraju, V. S., Rangel, M. O., Golzar, Y., Garcia-Sayan, E., & Hendel, R. C. (2013). Impact of appropriate use on the prognostic value of single-photon emission computed tomography myocardial perfusion imaging. Circulation, 128(15), 1634-1643. https://doi.org/10.1161/CIRCULATIONAHA.113.002744