A multicenter evaluation of the appropriate use of single-photon emission tomography myocardial perfusion imaging in Greece

Moralidis, Efstratios; Papadimitriou, Nafsika; Stathaki, Maria; Xourgia, Xanthi; Spyridonidis, Trifon; Fotopoulos, Andreas; Apostolopoulos, Dimitrios; Karkavitsas, Nikolaos; Gotzamani-Psarrakou, Anna

doi:10.1007/s12350-012-9664-0

Cited by 14 publications

(8 citation statements)

References 29 publications

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“…As shown in Table 2, these categorizations for PET appropriate use are similar to those found in the majority of reports with SPECT, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] although there are some reports of SPECT MPI with higher frequency of inappropriate studies. 19,27 For evaluation of the scintigraphic findings and outcomes, the authors have combined ''appropriate'' with ''uncertain'' categories, which although somewhat controversial, is consistent with the intent of these AUC-''uncertain is assumed to not provide grounds for denial of reimbursement.''…”

supporting

confidence: 72%

The value and appropriateness of positron emission tomography: An evolving tale

Hendel

2015

Journal of Nuclear Cardiology

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supporting

confidence: 72%

The value and appropriateness of positron emission tomography: An evolving tale

Hendel

2015

Journal of Nuclear Cardiology

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“…The 2005 AUC were used by 6 studies, 16,18,19,39,42,44 and the remainder used the 2009 AUC. 10–15,17,20,34–38,40,41,43 Single-photon emission computed tomography (SPECT) was the modality utilized in most of the studies, 13–20,34–36,38,39,41–44 one study reported using positron emission tomography (PET), 12 while the remainder of the studies did not specify. 10,11,37,40 Among the included studies, 5 were conducted outside the United States.…”

Section: Resultsmentioning

confidence: 99%

“…10,11,37,40 Among the included studies, 5 were conducted outside the United States. 11,17,34,38,41 Patients were recruited from the outpatient setting in 3 studies, 20,35,37 from an inpatient setting in 1 study, 10 and from both settings in 13 studies. 11–16,19,34,36,38,40,42,43 Overall, the summary rate for inappropriate testing was 14.8% (95% CI 11.6–18.7%).…”

Section: Resultsmentioning

confidence: 99%

Outcomes after inappropriate nuclear myocardial perfusion imaging: A meta-analysis

Elgendy

Mahmoud

Shuster

et al. 2016

Journal of Nuclear Cardiology

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Background The relationship between inappropriate MPI and cardiovascular outcomes is poorly understood. We sought to systematically review the literature on appropriate use criteria (AUC) for MPI, including temporal trend of inappropriate testing and resulting cardiovascular outcomes. Methods We searched the MEDLINE database for studies related to AUC and MPI. The co-primary outcomes were abnormal test results and the presence of cardiac ischemia. Random effects odds ratios (OR) were constructed using DerSimonian-Laird method. Results A total of 22 studies with 23,443 patients were included. The prevalence of inappropriate testing was 14.8 % [95% confidence interval (CI) 11.6–18.7%]. Inappropriate MPI studies were less likely to be abnormal (OR 0.41 95% CI 0.35–0.49, p<0.0001) and to demonstrate ischemia (OR 0.40, 95% CI 0.24–0.67, p<0.0001) compared to appropriate testing. No difference in the rate of inappropriate tests was detected based on the midpoint of the enrollment year (p=0.54). The pattern of ordering inappropriate studies was not different between cardiology and non-cardiology providers (OR 0.74, 95% CI 0.51–1.06, p=0.10). Conclusion Inappropriate MPI studies are less likely to yield abnormal results or demonstrate myocardial ischemia. The rate of inappropriate MPI has not decreased over time.

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“…Previous retrospective studies using the AUC to classify imaging have identified rates of up to 22 % for TTE in the category of rarely appropriate, from a variety of clinical settings [ 7 – 10 ]. Appropriateness studies of single-photon emission tomography myocardial perfusion imaging (SPECT), and cardiac catheterization have shown similar rates of rarely appropriate use [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of inpatient multimodal cardiac imaging appropriateness at large academic medical centers

Remfry

Abrams

Dudzinski

et al. 2015

Cardiovasc Ultrasound

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BackgroundResponding to concerns regarding the growth of cardiac testing, the American College of Cardiology Foundation (ACCF) published Appropriate Use Criteria (AUC) for various cardiac imaging modalities. Single modality cardiac imaging appropriateness has been reported but there have been no studies assessing the appropriateness of multiple imaging modalities in an inpatient environment.MethodsA retrospective study of the appropriateness of cardiac tests ordered by the inpatient General Internal Medicine (GIM) and Cardiology services at three Canadian academic hospitals was conducted over two one-month periods. Cardiac tests characterized were transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), single-photon emission tomography myocardial perfusion imaging (SPECT), and diagnostic cardiac catheterization.ResultsOverall, 553 tests were assessed, of which 99.8 % were classifiable by AUC. 91 % of all studies were categorized as appropriate, 4 % may be appropriate and 5 % were rarely appropriate. There were high rates of appropriate use of all modalities by GIM and Cardiology throughout. Significantly more appropriate diagnostic catheterizations were ordered by Cardiology than GIM (93 % vs. 82 %, p = <0.01). Cardiology ordered more appropriate studies overall (94 % vs. 88 %, p = 0.03) but there was no difference in the rate of rarely appropriate studies (3 % vs. 6 %, p = 0.23).ConclusionThe ACCF AUC captured the vast majority of clinical scenarios for multiple cardiac imaging modalities in this multi-centered study on Cardiology and GIM inpatients in the acute care setting. The rate of appropriate ordering was high across all imaging modalities. We recommend further work towards improving appropriate utilization of cardiac imaging resources focus on the out-patient setting.

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A multicenter evaluation of the appropriate use of single-photon emission tomography myocardial perfusion imaging in Greece

Abstract: The appropriate use of MPI is relatively high, but a considerable proportion of inappropriate scans is noted which is associated with markers of lower risk. The most common source of inappropriate testing is the assessment of asymptomatic patients <2 years after PCI.

Cited by 14 publications

References 29 publications

The value and appropriateness of positron emission tomography: An evolving tale

The value and appropriateness of positron emission tomography: An evolving tale

Outcomes after inappropriate nuclear myocardial perfusion imaging: A meta-analysis

Assessment of inpatient multimodal cardiac imaging appropriateness at large academic medical centers

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