A Multinational Study to Establish the Value of Early Adenosine Technetium-99m Sestamibi Myocardial Perfusion Imaging in Identifying a Low-Risk Group for Early Hospital Discharge After Acute Myocardial Infarction

Mahmarian, John J.; Shaw, Leslee J.; Filipchuk, Neil; Dakik, Habib A.; Iskander, Sherif; Ruddy, Terrence D.; Henzlova, Milena J.; Keng, Felix; Allam, Adel H.; Moyé, Lemuel A.; Pratt, Craig M.; Investigators, Inspire

doi:10.1016/j.jacc.2006.07.069

Cited by 118 publications

(69 citation statements)

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“…35,36 Stress-only adenosine could be done after one set of cardiac biomarkers as adenosine has been shown to be safe even in acute MI. 37 As in this study, using a stress-only protocol instead of a rest-stress protocol and a CZT SPECT camera to decrease imaging time from 20-25 to 3-5 minutes, extraneous time can be eliminated. ETT is an even faster diagnostic test for the low-risk patient and a provisional isotope injection protocol might provide the time savings of ETT with the flexibility of imaging when needed.…”

Section: 6mentioning

confidence: 92%

A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department

Duvall

Savino

Levine

et al. 2014

Journal of Nuclear Cardiology

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Background. Recent studies have compared CTA to stress testing and MPI using older Na-I SPECT cameras and traditional rest-stress protocols, but are limited by often using optimized CTA protocols but suboptimal MPI methodology. We compared CTA to stress testing with modern SPECT MPI using high-efficiency CZT cameras and stress-first protocols in an ED population.Methods. In a retrospective, non-randomized study, all patients who underwent CTA or stress testing (ETT or Tc-99m sestamibi SPECT MPI) as part of their ED assessment in 2010-2011 driven by ED attending preference and equipment availability were evaluated for their disposition from the ED (admission vs discharge, length of time to disposition), subsequent visits to the ED and diagnostic testing (within 3 months), and radiation exposure. CTA was performed using a 64-slice scanner (GE Lightspeed VCT) and MPI was performed using a CZT SPECT camera (GE Discovery 530c). Data were obtained from prospectively acquired electronic medical records and effective doses were calculated from published conversion factors. A propensity-matched analysis was also used to compare outcomes in the two groups.Results. A total of 1,458 patients underwent testing in the ED with 192 CTAs and 1,266 stress tests (327 ETTs and 939 MPIs). The CTA patients were a lower-risk cohort based on age, risk factors, and known heart disease. A statistically similar proportion of patients was discharged directly from the ED in the stress testing group (82% vs 73%, P 5 .27), but their time to disposition was longer (11.0 ± 5 vs 20.5 ± 7 hours, P < .0001). There was no significant difference in cardiac return visits to the ED (5.7% CTA vs 4.3% stress testing, P 5 .50), but more patients had follow-up studies in the CTA cohort compared to stress testing (14% vs 7%, P 5 .001). The mean effective dose of 12.6 ± 8.6 mSv for the CTA group was higher (P < .0001) than 5.0 ± 4.1 mSv for the stress testing group (ETT and MPI). A propensity score-matched cohort showed similar results to the entire cohort.Conclusions. Stress testing with ETT, high-efficiency SPECT MPI, and stress-only protocols had a significantly lower patient radiation dose and less follow-up diagnostic testing than CTA with similar cardiac return visits. CTA had a shorter time to disposition, but there was a trend toward more revascularization than with stress testing. (J Nucl Cardiol 2014;21:305-18.)

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Section: 6mentioning

confidence: 92%

A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department

Duvall

Savino

Levine

et al. 2014

Journal of Nuclear Cardiology

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“…First, our results confirm that many patients who present to the ED with ACP (57%) are not candidates for CTA either because of prior history of cardiovascular disease or a contraindication to the procedure (4,17). Conversely, SPECT has few contraindications and is an optimal test in patients with known CAD for whom the main clinical question is the presence and extent of myocardial ischemia (9,18). Second, radiation exposure was higher with CT than SPECT even though most patients (56%) underwent radiation-reduction Overall, 20 of 282 (7.1%) patients received ,5 mSv 12.7 ± 4.9 *P , 0.0001 stress-only vs. stress-rest.…”

Section: Discussionmentioning

confidence: 99%

Optimizing Evaluation of Patients with Low-to-Intermediate-Risk Acute Chest Pain: A Randomized Study Comparing Stress Myocardial Perfusion Tomography Incorporating Stress-Only Imaging Versus Cardiac CT

et al. 2015

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The purpose of this study was to determine whether stress myocardial perfusion (SPECT) optimized with stress-only (SO) imaging is comparable to cardiac CT angiography (CTA) for evaluating patients with acute chest pain (ACP). Methods: This was a prospective randomized observational study in 598 ACP patients who underwent CTA versus SPECT. The primary endpoint was length of hospital stay, and secondary endpoints were test feasibility, time to diagnosis, diagnostic accuracy, radiation exposure, and overall cost. Median follow-up was 6.5 mo, with a 3.8% cardiac event rate defined as death or an acute coronary syndrome. Results: Of 2,994 patients screened, 1,703 (56.9%) were not candidates for CTA because of prior cardiac disease (41%) or imaging contraindications (16%). Time to diagnosis (8.1 ± 8.5 vs. 9.4 ± 7.4 h) and length of hospital stay (19.7 ± 27.8 vs. 23.5 ± 34.4 h) were significantly shorter with CTA than with SPECT (P 5 0.002). However, time to diagnosis (7.0 ± 6.2 vs. 6.8 ± 5.9 h, P 5 0.20), length of stay (15.5 ± 17.2 vs. 16.7 ± 15.3 h, P 5 0.36), and hospital costs ($4,242 ± $3,871 vs. $4,364 ± 1781, P 5 0.86) were comparable with CTA versus SO SPECT, respectively. SO was also superior to conventional SPECT regarding all of the above metrics and significantly reduced radiation exposure (5.5 ± 4.4 vs. 12.5 ± 2.7 mSv, P , 0.0001). Conclusion: Stress SPECT when optimized with SO imaging is similar to CTA in time to diagnosis, length of hospital stay, and cost, with improved prognostic accuracy and less radiation exposure. Our results emphasize the importance of SO imaging, particularly in low-intermediate-risk emergency room patients who are a population likely to have a normal test result.

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“…4 There are multiple software packages that allow image interpretation in the fashion discussed above, and in general, are all based on circumferential profile analysis. The three most commonly available commercial ones are QPS (Cedars Sinai), Emory tool box (Emory), and 4D-MSPECT (Michigan).…”

Section: Quantitative Methods For Assessing Perfusionmentioning

confidence: 99%

“…Could serial imaging be used to assess progression or regression of left ventricular (LV) ischemia and thereby dynamically track risk, define the impact of a novel or old anti-ischemic therapy, or meet the standards of the Food and Drug administration (FDA) for approval of a new therapy, imaging agent, or stress agent? [2][3][4][5] The basic argument is not really whether quantitative analysis is needed to assess such serial changes in perfusion, but whether an automated program or a semiquantitative visual analysis should be routinely utilized. Our field has many examples that attest to the merits of automated analysis by gated SPECT for measuring many indices of LV function such as ejection fraction (EF), volumes, wall motion and thickening, transient dilation, and the more recently described indices of dyssynchrony by phase analysis.…”

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confidence: 99%

Automated assessment of serial SPECT myocardial perfusion images

Iskandrian

Garcia

Faber

et al. 2009

Journal of Nuclear Cardiology

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A Multinational Study to Establish the Value of Early Adenosine Technetium-99m Sestamibi Myocardial Perfusion Imaging in Identifying a Low-Risk Group for Early Hospital Discharge After Acute Myocardial Infarction

Abstract: Gated ADSPECT performed early after AMI can accurately identify a sizeable low-risk group who have a <2% death and reinfarction rate at 1 year. Identifying these low-risk patients for early hospital discharge may improve utilization of health care resources at considerable cost savings.

Cited by 118 publications

References 29 publications

A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department

A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department

Optimizing Evaluation of Patients with Low-to-Intermediate-Risk Acute Chest Pain: A Randomized Study Comparing Stress Myocardial Perfusion Tomography Incorporating Stress-Only Imaging Versus Cardiac CT

Automated assessment of serial SPECT myocardial perfusion images

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