Doukky Rami, Frogge Nathan, Appis Andrew, Hayes Kathleen, Khoudary George, Fogg Louis, Williams Kim A
Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois Division of Cardiology, Rush University Medical Center, Chicago, Illinois
Division of Cardiology, Rush University Medical Center, Chicago, Illinois Department of Internal Medicine, University of Chicago Medicine, Chicago, Illinois; and.
J Nucl Med. 2016 Aug;57(8):1251-7. doi: 10.2967/jnumed.115.167205. Epub 2016 Apr 21.
The impact of appropriate use criteria (AUC) for myocardial perfusion imaging (MPI) with SPECT on the estimated lifetime attributable risk (LAR) of cancer is unknown.
A cohort of 1,511 consecutive patients who underwent clinically indicated (99m)Tc-setamibi MPI were categorized into appropriate/uncertain (n = 823) versus inappropriate (n = 688) use groups according to the 2009 AUC and were prospectively followed for 27 ± 10 mo. Logistic regression models were used to determine the annualized probability of major adverse cardiac events (MACE) of cardiac death or myocardial infarction and the probability of revascularization within 6 mo of MPI, accounting for relevant covariates. We determined LAR for each subject on the basis of accepted risk estimates. We calculated MPI's benefit-to-risk ratios, defined by the annualized predicted MACE-to-LAR ratio and the predicted 6-mo-revascularization-to-LAR ratio.
During follow-up, there were 22 MACE and 29 6-mo revascularizations. The administered radioactivity and effective radiation doses absorbed were similar between the study groups. Patients with inappropriate MPI had significantly higher LAR (median, 0.08% vs. 0.06%, P < 0.001), lower predicted MACE-to-LAR ratio (median, 1.5 vs. 4.3, P < 0.001), and lower predicted 6-mo-revascularization-to-LAR ratio (median, 5.4 vs. 15.5, P < 0.001). Women had higher LAR (median, 0.08% vs. 0.07%, P < 0.001) and lower predicted MACE-to-LAR ratio (median, 1.9 vs. 3.3, P < 0.001) and 6-mo-revascularization-to-LAR ratio (median, 4.4 vs. 17.5, P < 0.001). However, appropriate/uncertain use negated the difference between men and women in LAR (P = 0.94) and the predicted MACE-to-LAR ratio (P = 0.97).
Inappropriate MPI use is associated with excess cancer risk and lower MPI's benefit-to-risk ratio. Appropriate/uncertain use neutralizes the sex gap in LAR with MPI.
单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）的合理使用标准（AUC）对癌症估计终生归因风险（LAR）的影响尚不清楚。
对1511例连续接受临床指征的（99m）锝-甲氧基异丁基异腈MPI检查的患者，根据2009年AUC分为合理/不确定组（n = 823）和不合理组（n = 688），并进行前瞻性随访27±10个月。采用逻辑回归模型确定心脏死亡或心肌梗死这一主要不良心脏事件（MACE）的年化概率以及MPI后6个月内血运重建的概率，并考虑相关协变量。我们根据公认的风险估计值确定每个受试者的LAR。我们计算了MPI的效益风险比，定义为年化预测MACE与LAR之比以及预测6个月血运重建与LAR之比。
随访期间，发生22例MACE和29例6个月血运重建。各研究组之间的给药放射性和吸收的有效辐射剂量相似。MPI使用不合理的患者LAR显著更高（中位数，0.08%对0.06%，P < 0.001），预测的MACE与LAR之比更低（中位数，1.5对4.3，P < 0.001），预测的6个月血运重建与LAR之比更低（中位数，5.4对15.5，P < 0.001）。女性的LAR更高（中位数，0.08%对0.07%，P < 0.001），预测的MACE与LAR之比更低（中位数，1.9对3.3，P < 0.001），6个月血运重建与LAR之比更低（中位数，4.4对17.5，P < 0.001）。然而，合理/不确定使用消除了男性和女性在LAR方面的差异（P = 0.94）以及预测的MACE与LAR之比方面的差异（P = 0.97）。
MPI使用不合理与癌症风险增加以及MPI的效益风险比降低相关。合理/不确定使用消除了MPI在LAR方面的性别差异。
