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Clinical utility of inappropriate positron emission tomography myocardial perfusion imaging: Test results and cardiovascular events

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Appropriate use criteria for myocardial perfusion imaging (MPI) were developed to categorize scenarios where MPI might be beneficial (appropriate) or not (inappropriate). Few investigations have evaluated the clinical utility of this categorization strategy, particularly with positron emission tomography (PET) MPI.

Methods and Results

We conducted this retrospective cohort investigation in a Veterans Affairs (VA) medical center, on predominantly male subjects who underwent PET-MPI. We correlated appropriateness to test result and cardiovascular events. Of 521 subjects, 414 (79.5%) were appropriate, 54 (10.4%) were uncertain, and 53 (10.2%) were inappropriate. PET-MPI was abnormal more often when appropriate or uncertain (28% and 34.6%, respectively, vs 7.7% for inappropriate, P = .003). Among abnormal inappropriate tests, none detected occult ischemia. By Cox regression, summed difference score ≥5 (HR 5.06, 95% CI 2.72-9.44) and an abnormal test result (HR 4.48, 95% CI 2.19-9.14) were associated with higher likelihood of catheterization. Log-rank analysis demonstrated similar likelihood of catheterization when comparing abnormal vs normal test result (P < .0001) and between appropriate, uncertain, and inappropriate tests (P = .024).

Conclusions

Inappropriate PET-MPI was rarely abnormal, associated with low catheterization rates, and failed to detect occult ischemia for any subjects. The clinical utility of inappropriate PET-MPI is negligible.

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Acknowledgments

This work was supported by resources provided by the North Florida/South Georgia Veterans Health System. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Disclosure

This investigation was supported by NIH T35 Training Grant: T35-HL007489-28. Dr Winchester had full access to the data and accepts responsibility for its integrity.

Author information

Authors and Affiliations

  1. Malcom Randall VA Medical Center, 1601 SW Archer Rd 111D, Gainesville, FL, 32608, USA

    David E. Winchester MD, MS, Raman Dusaj MD & Rebecca J. Beyth MD MSc

  2. College of Medicine, University of Florida, Gainesville, FL, 32608, USA

    David E. Winchester MD, MS, Ryan J. Chauffe DO, Ryan Meral BA, Daniel Nguyen MD, Scott Ryals MD, Raman Dusaj MD & Rebecca J. Beyth MD MSc

  3. Emory University School of Medicine, Atlanta, GA, USA

    Leslee Shaw PhD

Authors
  1. David E. Winchester MD, MS
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  2. Ryan J. Chauffe DO
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  3. Ryan Meral BA
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  4. Daniel Nguyen MD
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  5. Scott Ryals MD
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  6. Raman Dusaj MD
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  7. Leslee Shaw PhD
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  8. Rebecca J. Beyth MD MSc
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Corresponding author

Correspondence to David E. Winchester MD, MS.

Additional information

See related editorial, doi: 10.1007/s12350-014-9962-9

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Winchester, D.E., Chauffe, R.J., Meral, R. et al. Clinical utility of inappropriate positron emission tomography myocardial perfusion imaging: Test results and cardiovascular events. J. Nucl. Cardiol. 22, 9–15 (2015). https://doi.org/10.1007/s12350-014-9925-1

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  • DOI: https://doi.org/10.1007/s12350-014-9925-1

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