College of Medicine, University of Florida, Gainesville, FL, USA.
Cardiovascular Medicine Department, Boston Medical Center, 88 East Newton Pavilion, Boston, MA, 02218, USA.
J Nucl Cardiol. 2019 Jun;26(3):826-830. doi: 10.1007/s12350-017-0965-1. Epub 2017 Jun 28.
Appropriate use criteria (AUC) developed by the American College of Cardiology Foundation and the appropriateness criteria (AC) developed by the American College of Radiology (ACR) are two existing methods of rating appropriateness of myocardial perfusion imaging (MPI). One study found poor agreement of ratings between the two methods. However, using the most contemporary AUC from 2013, it is unknown if poor agreement still exists.
Retrospective cohort investigation comparing patients undergoing nuclear MPI between June 2011 and September 2014. The appropriateness category was determined based on the 2013 AUC (Appropriate, may be appropriate, rarely appropriate) and the 2010 ACR AC (usually appropriate, maybe appropriate, usually not appropriate). The primary outcome was the degree of the agreement between the two methods.
The kappa coefficient between ACR AC and AUC was 0.32, P < 0.0001, indicating poor agreement; 40 (8%) patients were classified by the AUC but could not be classified by the ACR AC.
The two methods for rating the appropriateness of MPI have poor agreement; a potential for disagreement between providers and payers if only one method is used.
美国心脏病学会基金会制定的适宜性标准（AUC）和美国放射学院制定的适宜性标准（ACR）是两种现有的心肌灌注成像（MPI）适宜性评分方法。一项研究发现，这两种方法的评分一致性较差。然而，使用 2013 年最新的 AUC，是否仍存在较差的一致性尚不清楚。
回顾性队列研究比较了 2011 年 6 月至 2014 年 9 月期间接受核 MPI 的患者。适宜性类别是根据 2013 年 AUC（适宜、可能适宜、很少适宜）和 2010 年 ACR AC（通常适宜、可能适宜、通常不适宜）确定的。主要结局是两种方法之间的一致性程度。
ACR AC 和 AUC 之间的 Kappa 系数为 0.32，P<0.0001，表明一致性较差；40（8%）名患者根据 AUC 进行分类，但不能根据 ACR AC 进行分类。
两种 MPI 适宜性评分方法的一致性较差；如果仅使用一种方法，提供者和支付者之间可能存在分歧。
