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 Hendel

Research output: Contribution to journalArticle

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

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Myocardial Perfusion Imaging
Single-Photon Emission-Computed Tomography
Myocardial Infarction
Patient Selection
Myocardial Ischemia
Cohort Studies
Outpatients
Perfusion
Prospective Studies
Mortality

Keywords

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

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Doukky, R., Hayes, K., Frogge, N., Balakrishnan, G., Dontaraju, V. S., Rangel, M. O., ... Hendel, R. (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

Impact of appropriate use on the prognostic value of single-photon emission computed tomography myocardial perfusion imaging. / Doukky, Rami; Hayes, Kathleen; Frogge, Nathan; Balakrishnan, Gautam; Dontaraju, Venkata Satish; Rangel, Maria O.; Golzar, Yasmeen; Garcia-Sayan, Enrique; Hendel, Robert.

In: Circulation, Vol. 128, No. 15, 08.10.2013, p. 1634-1643.

Research output: Contribution to journalArticle

Doukky, R, Hayes, K, Frogge, N, Balakrishnan, G, Dontaraju, VS, Rangel, MO, Golzar, Y, Garcia-Sayan, E & Hendel, R 2013, 'Impact of appropriate use on the prognostic value of single-photon emission computed tomography myocardial perfusion imaging', Circulation, vol. 128, no. 15, pp. 1634-1643. https://doi.org/10.1161/CIRCULATIONAHA.113.002744
Doukky, Rami ; Hayes, Kathleen ; Frogge, Nathan ; Balakrishnan, Gautam ; Dontaraju, Venkata Satish ; Rangel, Maria O. ; Golzar, Yasmeen ; Garcia-Sayan, Enrique ; Hendel, Robert. / Impact of appropriate use on the prognostic value of single-photon emission computed tomography myocardial perfusion imaging. In: Circulation. 2013 ; Vol. 128, No. 15. pp. 1634-1643.
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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.",
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AU - Hayes, Kathleen

AU - Frogge, Nathan

AU - Balakrishnan, Gautam

AU - Dontaraju, Venkata Satish

AU - Rangel, Maria O.

AU - Golzar, Yasmeen

AU - Garcia-Sayan, Enrique

AU - Hendel, Robert

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N2 - 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.

AB - 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.

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