Center for Interventional Vascular Therapy, Division of Cardiovascular Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
J Nucl Cardiol. 2013 Dec;20(6):1041-8. doi: 10.1007/s12350-013-9794-z. Epub 2013 Oct 18.
Appropriate use criteria (AUC) for single-photon emission computed tomography myocardial perfusion images (SPECT-MPI) were developed to address the growth of cardiac imaging studies. However, these criteria have not been vigorously validated. We sought to determine the rate of abnormal stress SPECT-MPI studies and subsequent revascularization procedures as categorized by AUC.
We retrospectively examined 280 patients who underwent stress SPECT-MPI and categorized these studies as appropriate, inappropriate, or uncertain based on AUC. Data regarding subsequent angiography and revascularization within 6 months after stress SPECT-MPI were collected from the electronic medical record.
280 patients met the inclusion criteria (mean age 67.3 ± 11.4 years, 36 % female). When categorized by AUC, 62.9 % (N = 176) of stress SPECT-MPI were considered appropriate, 13.6 % (N = 38) uncertain, and 23.6 % (N = 66) inappropriate. Appropriate stress SPECT-MPI studies were more likely to have intermediate or high risk results than uncertain or inappropriate studies [40 % (N = 71) vs. 21 % (N = 8) and 18 % (N = 12), respectively; P = 0.008)]. Appropriate studies were associated with an increased rate of coronary angiography [14 % (N = 25)] compared to the uncertain (0 %) and inappropriate [3 % (N = 2)] studies (P = 0.003). There was also an increased rate of revascularization after appropriate studies [9 % (N = 16)] compared to the uncertain (0 %) and inappropriate (0 %) studies (P = 0.006).
Appropriate stress SPECT-MPI studies are more likely to result in abnormal results requiring subsequent revascularization compared to inappropriate and uncertain stress studies. Inappropriate and uncertain stress SPECT-MPI did not lead to subsequent revascularization.
为了解决心脏成像研究的增长问题，制定了单光子发射计算机断层心肌灌注图像（SPECT-MPI）的适当使用标准（AUC）。然而，这些标准尚未得到有力验证。我们试图确定根据 AUC 分类的异常应激 SPECT-MPI 研究和随后的血运重建程序的发生率。
我们回顾性检查了 280 名接受应激 SPECT-MPI 的患者，并根据 AUC 将这些研究归类为适当、不适当或不确定。从电子病历中收集了应激 SPECT-MPI 后 6 个月内随后进行的血管造影和血运重建的数据。
280 名患者符合纳入标准（平均年龄 67.3±11.4 岁，36%为女性）。根据 AUC 分类，62.9%（N=176）的应激 SPECT-MPI 被认为是适当的，13.6%（N=38）为不确定的，23.6%（N=66）为不适当的。适当的应激 SPECT-MPI 研究更有可能出现中高危结果，而不确定或不适当的研究则不太可能出现中高危结果[分别为 40%（N=71）、21%（N=8）和 18%（N=12）；P=0.008]。适当的研究与冠状动脉造影的增加率相关[14%（N=25）]，而不确定的（0%）和不适当的（3%）研究则没有[P=0.003]。适当的研究后也有更高的血运重建率[9%（N=16）]，而不确定的（0%）和不适当的（0%）研究则没有[P=0.006]。
与不适当和不确定的应激研究相比，适当的应激 SPECT-MPI 研究更有可能导致需要随后进行血运重建的异常结果。不适当和不确定的应激 SPECT-MPI 并未导致随后的血运重建。
