Impact on exercise single-photon emission computed tomographic thallium imaging on patient management and outcome

Nallamothu, Nasaraiah; Pancholy, Samir; Lee, Kwan R.; Heo, Jaekyeong; Iskandrian, Abdulmassih S.

doi:10.1016/s1071-3581(05)80078-9

Cited by 52 publications

(9 citation statements)

References 22 publications

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“…This underlines the clinical value of MPI with PET. We found only 1% of patients who underwent CABG despite normal PET MPI, comparing favorably with the 3-4% reported in retrospective studies with SPECT MPI in patients with unknown CAD [25,26]. Conversely, the proportion of patients in our study who underwent PCI or CABG after detection of ischemia was 56%, lying well within the range of 36-60% reported in previous studies [25,26].…”

Section: Discussionsupporting

confidence: 86%

13N-ammonia myocardial perfusion imaging with a PET/CT scanner: impact on clinical decision making and cost-effectiveness

Siegrist

Husmann

Knabenhans

et al. 2007

Eur J Nucl Med Mol Imaging

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Section: Discussionsupporting

confidence: 86%

13N-ammonia myocardial perfusion imaging with a PET/CT scanner: impact on clinical decision making and cost-effectiveness

Siegrist

Husmann

Knabenhans

et al. 2007

Eur J Nucl Med Mol Imaging

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“…perfusion imaging, then despite the determined significant coronary stenosis no revascularisation was performed and more importantly, no cardiovascular events were reported in the case of these patients. Similar results were obtained in the study of Nalla mothu et al [17] in which 2700 patients suspected of CAD underwent myocardial perfusion scintigraphy and it was determined that the lack of perfusion disorders was correlated to a statistically significant extent with lower percentage of both serious cardiovascular complications and necessary revascularisation procedures.…”

Section: Discussionsupporting

confidence: 83%

The prognostic value of myocardial perfusion scintigraphy compared to coronary angiography in women with positive stress test results

Miernik¹,

Kaźmierczak‐Dziuk²,

Kamiński³

et al. 2012

Nucl Med Rev Cent East Eur

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BACKGROUND:Modern diagnostic strategy in coronary artery disease (CAD) makes it necessary not only to establish a dia gnosis but also to assess the cardiovascular risk. It is not clear which strategy should be followed in the case of women with positive ECG stress test results to assess prognosis and start appropriate diagnostics and treatment.The aim of the study was to assess the prognostic value of myocardial perfusion scintigraphy in comparison with coronary angiography in women suspected of CAD and with positive ECG stress test results. MATERIAL AND METHODS:The study population comprised 115 women (mean age 58.08 ± 8. RESULTS:The evaluation period covered 43.2 ± 30.8 months on average. The sensitivity of myocardial perfusion scintigraphy against cardiovascular events was 100% and the sensitivity of coronary angiography was 92.3%. The specificity was 93.1% and 88.9% respectively.The PPV of scintigraphy for cardiovascular events was 65% and of coronary angiography was 70.6%. The NPV was 100% and 97.6%respectively. The accuracy of myocardial perfusion scintigraphy for cardiovascular events was 93.9% and the accuracy of coronary angiography for cardiovascular events was 89.7%. The survival analysis confirmed the high prognostic value of SPECT and coro nary angiography. However, if compared, myocardial perfusion scintigraphy was a better predictor of survival without cardiovas cular events than coronary angiography was (c 2 = 9.39, p < 0.01).The most important factors in assessing the cardiovascular risk in the study population included: positive result of myocardial perfusion scintigraphy, positive result of coronary angiography, and high SCORE and high POSTTEST values. CONCLUSIONS:Myocardial perfusion scintigraphy is superior to coronary angiography in the prediction of necessary revas

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“…The scant literature that has examined angiographic rates after SPECT MPI shows that, in general, referral for coronary angiography does parallel the pCAD: Angiography rates of 17%-50% are reported for patients with an intermediate likelihood of CAD (11,16,31,32). Importantly, in the few studies that report subsequent myocardial revascularization rates, the frequency of revascularization increases directly with the increased utilization of coronary arteriography, independent of other clinical factors.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…Nallamothu et al found an angiography rate of 29% after exercise SPECT and a 30% rate of subsequent revascularization within 3 mo of coronary arteriography guided by adenosine SPECT MPI. (31,32). …”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Impact of Myocardial Perfusion Imaging with PET and 82Rb on Downstream Invasive Procedure Utilization, Costs, and Outcomes in Coronary Disease Management

Merhige¹,

Breen²,

Shelton³

et al. 2007

Journal of Nuclear Medicine

119

103

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We hypothesized that PET myocardial perfusion imaging with 82 Rb (PET MPI), would reduce downstream utilization of diagnostic arteriography, compared with SPECT, in patients matched for pretest likelihood of coronary disease (pCAD). PET MPI is more accurate for assessment of impaired coronary flow reserve compared with SPECT MPI, potentially reducing the demand for subsequent arteriography, percutaneous transcoronary intervention, and coronary artery bypass grafting (CABG), with attendant cost savings, while avoiding a negative impact on coronary events. Methods: The frequency of diagnostic arteriography, revascularization, costs, and 1-y clinical outcomes in 2,159 patients studied with PET MPI was compared with 2 control groups studied with SPECT MPI matched to the PET group by pCAD: an internal control group of 102 patients and an external SPECT control group of 5,826 patients. CAD management costs were approximated with realistic global fee estimates. Results: Arteriography rates were 0.34 and 0.31 for the external and internal control SPECT groups and 0.13 for the patients studied with PET (P , 0.0001). pCAD averaged 0.39 in patients studied with PET MPI, and in the external SPECT control group, and 0.37 in the internal SPECT controls. Revascularization rates were 0.13 and 0.11 for external and internal SPECT patients and 0.06 for the PET group (P , 0.0001; P , 0.01), with a cost savings of 30% noted for PET patients, with no significant difference in cardiac death or myocardial infaction at 1-y follow-up. Conclusion: PET MPI in patients with intermediate pCAD results in a .50% reduction in invasive coronary arteriography and CABG, a 30% cost savings, and excellent clinical outcomes at 1 y compared with SPECT.

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Impact on exercise single-photon emission computed tomographic thallium imaging on patient management and outcome

Abstract: The results of exercise SPECT thallium imaging are important in patient management and outcome. Coronary angiography, coronary revascularization and events are rare in patients with normal exercise SPECT thallium images.

Cited by 52 publications

References 22 publications

13N-ammonia myocardial perfusion imaging with a PET/CT scanner: impact on clinical decision making and cost-effectiveness

13N-ammonia myocardial perfusion imaging with a PET/CT scanner: impact on clinical decision making and cost-effectiveness

The prognostic value of myocardial perfusion scintigraphy compared to coronary angiography in women with positive stress test results

Impact of Myocardial Perfusion Imaging with PET and 82Rb on Downstream Invasive Procedure Utilization, Costs, and Outcomes in Coronary Disease Management

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