The prognostic value of cardiac SPECT performed at the primary care physician’s office

Abstract

Background. The prognostic value of single-photon emission computed-tomography (SPECT)-myocardial perfusion imaging (MPI) is well documented. However, the utility of SPECT-MPI when performed at a low-volume primary care physician's (PCP's) office is unknown.Methods. We conducted a prospective cohort study of consecutive patients referred by their PCP to undergo a stress-MPI at the PCP's office using a mobile laboratory. Major adverse cardiovascular events (MACE) of death, myocardial infarction (MI), and coronary revascularization were prospectively tabulated using mail and telephone interviews, chart review, and social security death index.Results. One thousand three hundred ninety subjects [mean age 58 ± 13 years; 44% women] were followed for 27 ± 9 months, with a 99% complete follow-up rate. Subjects with abnormal MPI [174 (12.5%)] had significantly higher rates of all-cause mortality [5.2% vs 1.0%, P < .001], death, or MI [5.7% vs 1.5%, P = .001], and the composite of death, MI, or late revascularization (>60 days post-MPI) [12.6 vs 2.7%, P < .001]. Overall MACE risk was associated with the total perfusion abnormality burden, while the revascularization rate was related to the reversible perfusion abnormality burden.Conclusion. Contemporary SPECT-MPI performed in the setting of a PCP's office carries a robust prognostic value, similar to that reported in tertiary or large-volume practice settings. (J Nucl Cardiol 2013;20:519-28.) Key Words: SPECT AE myocardial perfusion imaging (MPI) AE prognosis AE outcome AE primary care physician (PCP)

Impact of Appropriate Use on the Prognostic Value of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging

“…[1][2][3][4][5][6] Numerous studies have demonstrated that abnormal MPI predicts a multifold increase in the risk of major adverse cardiac events (MACE). [1][2][3][4][5][6] Furthermore, the prognostic utility of MPI is incremental to clinical, treadmill stress test, and coronary angiography data. [7][8][9] The robust prognostic data, favorable diagnostic performance, and wide availability of SPECT-MPI have led to a great expansion in use with consequent excessive expenditure.…”

Role of coronary artery calcium score for risk stratification in patients with non significant perfusion defects by myocardial perfusion single photon emission computed tomography

“…Hachamovitch et al [15] in a study involving 5,183 patients, followed by an average period of 642 days, showed that the annual rate of myocardial infarction was 0.5% in normal examinations, 2.7% had mild perfusion deficit, 2.9% for moderate deficit and 4.2% when there was severe impairment by SPECT. Doukky et al [16], in a study encompassing 1,390 followed by an average period of 27 months demonstrated that patients with perfusion deficits in mild to moderate magnitude showed HR for adverse events of 2.3 (95% CI 1.1-4.7, p = 0.02). On the other hand, non significant perfusion defects may be related to various clinical situations, such as the presence of endothelial dysfunction (an early marker of CAD), arrhythmias and myocardial hypertrophy without concomitant significant obstructive lesion, as well as a higher rate of equivocal studies due to attenuation artifacts, movement and gating, arrhythmias, conduction disturbances, errors of acquisition and post processing [17,18].…”

Impact of Appropriate Use on the Estimated Radiation Risk to Men and Women Undergoing Radionuclide Myocardial Perfusion Imaging

“…Two multivariable logistic regression models were fit to calculate the predicted probability of MACE (model 1) or revascularization within 6 mo (model 2) as determined by established clinical and imaging predictors (independent variables) known to affect these outcomes (1,9,12,16). The calculated probabilities of MACE were then annualized.…”

“…Myocar dial perfusion imaging (MPI) with SPECT is a pivotal tool in the risk assessment and clinical decision making in patients with known or suspected coronary artery disease (CAD) (1). The costly expansion in MPI use prompted professional organizations to develop appropriate use criteria (AUC) to guide physicians on the optimal use of SPECT MPI (2).…”