Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA.
J Nucl Cardiol. 2022 Jun;29(3):1141-1155. doi: 10.1007/s12350-020-02419-3. Epub 2020 Nov 5.
The use of myocardial perfusion imaging (MPI) in the management of coronary artery disease (CAD) is well established. Although prior studies have shown disparities in the use of invasive angiography in patients with acute MI, data on factors affecting referral to angiography post-MPI are lacking. We sought to evaluate the primary determinants of referral to invasive angiography post-MPI and specifically assess the role of non-traditional non-clinical factors such as race/ethnicity, socioeconomic factors, insurance status, and marital status.
All patients without known CAD who underwent stress SPECT MPI over 15 years were reviewed and the performance of coronary angiography within 90 days of their MPI was recorded. Multiple factors were analyzed for an association with referral to angiography, including exercise and MPI results, baseline demographics, traditional cardiac risk factors, and non-traditional factors such as ethnicity, insurance, marital and socioeconomic status. In a secondary analysis, these factors were assessed with regard to abnormal MPI results.
Out of 27,895 total patients, 2,150 (7.7%) underwent invasive coronary angiography. On multivariate analysis, inpatient location, positive ECG response, and abnormal MPI results were the strongest predictors of angiography. Non-traditional factors such as race/ethnicity and insurance status had a significant association with referral to angiography with Caucasians (OR 1.42, 95% CI 1.18-1.71, P < .0001) and those with private insurance (OR 1.35, 95% CI 1.13-1.62, P = .001) or Medicare (OR 1.30, 95% CI 1.08-1.56, P = .006) having higher rates of angiography despite controlling for traditional risk factors and test results.
Our study results indicate that non-traditional factors such as race/ethnicity and insurance status influence patient management decisions and impact the performance of downstream cardiac invasive testing after stress MPI. Higher rates of angiography in Caucasians, privately insured and Medicare patients were seen despite controlling for traditional risk factors and abnormal test results. Further research is needed to better understand these disparities, especially in the current healthcare environment.
心肌灌注成像（MPI）在冠心病（CAD）管理中的应用已得到充分证实。尽管先前的研究表明，急性心肌梗死患者接受有创血管造影术的差异，但缺乏关于影响 MPI 后血管造影术转诊因素的数据。我们旨在评估 MPI 后血管造影术转诊的主要决定因素，并特别评估种族/民族、社会经济因素、保险状况和婚姻状况等非传统非临床因素的作用。
回顾了 15 年来所有无已知 CAD 病史并接受应激 SPECT MPI 的患者，并记录了其 MPI 后 90 天内的冠状动脉造影情况。分析了多种因素与血管造影术转诊的关系，包括运动和 MPI 结果、基线人口统计学、传统心脏危险因素以及非传统因素，如种族、保险、婚姻和社会经济状况。在二次分析中，评估了这些因素与异常 MPI 结果的关系。
在 27895 名患者中，2150 名（7.7%）接受了有创冠状动脉造影术。多变量分析显示，住院地点、心电图阳性反应和异常 MPI 结果是血管造影术的最强预测因素。非传统因素，如种族/民族和保险状况与转诊至血管造影术有显著关联，白人（OR 1.42，95%CI 1.18-1.71，P<0.0001）和私人保险（OR 1.35，95%CI 1.13-1.62，P=0.001）或医疗保险（OR 1.30，95%CI 1.08-1.56，P=0.006）的患者尽管控制了传统危险因素和检测结果，但接受血管造影术的比率更高。
我们的研究结果表明，种族/民族和保险状况等非传统因素会影响患者的管理决策，并影响应激 MPI 后下游心脏有创性检查的执行。尽管控制了传统危险因素和异常检测结果，仍观察到白人、私人保险和医疗保险患者接受血管造影术的比率更高。需要进一步研究以更好地了解这些差异，尤其是在当前的医疗保健环境中。
