Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction

Abstract

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A Blood-Based Gene Expression Test for Obstructive Coronary Artery Disease Tested in Symptomatic Nondiabetic Patients Referred for Myocardial Perfusion Imaging The COMPASS Study

“…A recent meta-analysis of MPI studies with angiographic end points found a median sensitivity of 81% and specificity of 65%. 37 When we applied a referral bias correction to these data (see Methods), 19 using recent estimates of angiography referral rates for positive (48.2%) and negative (6.2%) MPI results, 38 the unbiased estimates of MPI performance were 35% sensitivity and 94% specificity. These estimates are very similar to the core-laboratory results obtained in this study, which had minimal referral bias by design, and suggest that our results are consistent with the literature after verification bias removal.…”

SPECT Myocardial Perfusion Reserve in Patients with Multivessel Coronary Disease: Correlation with Angiographic Findings and Invasive Fractional Flow Reserve Measurements

“…Becauseofi ts wide availability, noninvasiveness, and high diagnostic performance, myocardial perfusion imaging (MPI) using SPECT has become of common practice for coronary artery disease (CAD) screening, characterization, and follow-up (1,2). The standard semiquantitative approach based on the analysis of reversible perfusion defects between stress and rest images has excellent sensitivity and negative predictive value for ischemic lesion detection (3).…”

Comparison of Cardiovascular Magnetic Resonance and Single-Photon Emission Computed Tomography in Women With Suspected Coronary Artery Disease From the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease (CE-MARC) Trial

“…21 The diagnostic performance of SPECT in this substudy and in the main CE-MARC trial is lower than in previous studies (sensitivity range, 63%-93%; specificity range, 10%-90%), although the data lie within the published 95% confidence interval. 25,26 The reason is that CE-MARC was a prospective study, deliberately designed to minimize any selection (referral) bias. In contrast, the trials that contribute to the majority of prior SPECT data are all subject to either a pretest selection bias (only patients warranting coronary angiography enrolled) or a posttest selection bias (only positive SPECT cases referred for coronary angiography), leading to overestimation of the true diagnostic accuracy.…”