Skip to main content

Advertisement

Log in

Cardiac Radionuclide Imaging After Coronary Artery Revascularization

  • Cardiac Nuclear Imaging (A Cuocolo Section Editor)
  • Published:
Current Cardiovascular Imaging Reports Aims and scope Submit manuscript

Abstract

In the last decades, advances in the therapeutic options for cardiovascular diseases, coupled with improvements in imaging technology contributed to the explosive growth in the number of cardiovascular imaging procedures performed, which also raised concern about overuse. The decision whether cardiac imaging is reasonable or not should be based on how the information gained will influence subsequent patient care and outcomes. Appropriate use criteria have been developed by the major scientific societies and the resulting documents aim to categorize specific clinical scenarios and to indicate whether an imaging test is reasonable to perform, or whether the test has uncertain or inappropriate indications. Imaging decisions based on these authoritative criteria provides assurance that the test is reasonable and the clinical benefits outweigh the potential risks. This review focuses on the value of cardiac radionuclide imaging after coronary artery revascularization, in particular in clinical subgroups of subjects for whom uncertainty still exist.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Pranavchand R, Reddy BM. Current status of understanding of the genetic etiology of coronary heart disease. J Postgrad Med. 2013;59:30–41.

    Article  CAS  PubMed  Google Scholar 

  2. Ford ES. Trends in predicted 10-year risk of coronary heart disease and cardiovascular disease among U.S. adults from 1999 to 2010. J Am Coll Cardiol. 2013;61:2249–52.

    Article  PubMed  Google Scholar 

  3. Go AS, Mozaffarian D, Roger VL, American Heart Association Statistics Committee and Stroke Statistics Subcommittee, et al. Heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245.

    Article  PubMed  Google Scholar 

  4. Riley RF, Don CW, Powell W, Maynard C, Dean LS. Trends in coronary revascularization in the United States from 2001 to 2009: recent declines in percutaneous coronary intervention volumes. Circ Cardiovasc Qual Outcomes. 2011;4:193–7.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Epstein AJ, Polsky D, Yang F, Yang L, Groeneveld PW. Coronary revascularization trends in the United States, 2001-2008. JAMA. 2011;305:1769–76.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Iglehart JK. Health insurers and medical-imaging policy–a work in progress. N Engl J Med. 2009;360:1030–7.

    Article  CAS  PubMed  Google Scholar 

  7. Levin DC, Rao VM, Parker L, Frangos AJ, Intenzo CM. Recent payment and utilization trends in radionuclide myocardial perfusion imaging: comparison between self-referral and referral to radiologists. J Am Coll Radiol. 2009;6:437–41.

    Article  PubMed  Google Scholar 

  8. Patel MR, Spertus JA, Brindis RG, American College of Cardiology Foundation, et al. ACCF proposed method for evaluating the appropriateness of cardiovascular imaging. J Am Coll Cardiol. 2005;46:1606–13.

    Article  PubMed  Google Scholar 

  9. Levin DC, Parker L, Intenzo CM, Rao VM. Recent reimbursement changes and their effect on hospital and private office use of myocardial perfusion imaging. J Am Coll Radiol. 2013;10:198–201.

    Article  PubMed  Google Scholar 

  10. Carr JJ, Hendel RC, White RD, et al. 2013 appropriate utilization of cardiovascular imaging: a methodology for the development of joint criteria for the appropriate utilization of cardiovascular imaging by the American College of Cardiology Foundation and American College of Radiology. J Am Coll Cardiol. 2013;61:2199–206. This paper details the history, rationale, and methodology for developing joint documents for appropriate utilization of cardiovascular imaging.

    Article  PubMed  Google Scholar 

  11. Patel MR, White RD, Abbara S, American College of Radiology Appropriateness Criteria Committee; American College of Cardiology Foundation Appropriate Use Criteria Task Force, et al. 2013 ACCF/ACR/ASE/ASNC/SCCT/SCMR appropriate utilization of cardiovascular imaging in heart failure: a joint report of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Foundation Appropriate Use Criteria Task Force. J Am Coll Cardiol. 2013;61:2207–31.

    Article  PubMed  Google Scholar 

  12. Hendel RC, Berman DS, Di Carli MF, American College of Cardiology Foundation Appropriate Use Criteria Task Force; American Society of Nuclear Cardiology; American College of Radiology; American Heart Association; American Society of Echocardiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; Society of Nuclear Medicine, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. J Am Coll Cardiol. 2009;53:2201–29.

    Article  PubMed  Google Scholar 

  13. Brindis RG, Douglas PS, Hendel RC, American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group; American Society of Nuclear Cardiology; American Heart Association, et al. ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association. J Am Coll Cardiol. 2005;46:1587–605.

    Article  PubMed  Google Scholar 

  14. Farrell MB, Cerqueira MD. Understanding appropriate use criteria in nuclear medicine. J Nucl Med Technol. 2012;40:81–6.

    Article  PubMed  Google Scholar 

  15. Shah BR, Cowper PA, O’Brien SM, et al. Patterns of cardiac stress testing after revascularization in community practice. J Am Coll Cardiol. 2010;56:1328–34.

    Article  PubMed  Google Scholar 

  16. Hendel RC, Patel MR, Kramer CM, American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group; American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006;48:1475–97.

    Article  PubMed  Google Scholar 

  17. American College of Cardiology Foundation Appropriate Use Criteria Task Force; American Society of Echocardiography; American Heart Association; American Society of Nuclear Cardiology; Heart Failure Society of America; Heart Rhythm Society; Society for Cardiovascular Angiography and Interventions; Society of Critical Care Medicine; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance, Douglas PS, Garcia MJ, Haines DE, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol. 2011;57:1126–66.

    Article  PubMed  Google Scholar 

  18. Beller GA. Stress testing after coronary revascularization too much, too soon. J Am Coll Cardiol. 2010;56:1335–7.

    Article  PubMed  Google Scholar 

  19. Taylor AJ, Cerqueira M, Hodgson JM, American College of Cardiology Foundation Appropriate Use Criteria Task Force; Society of Cardiovascular Computed Tomography; American College of Radiology; American Heart Association; American Society of Echocardiography; American Society of Nuclear Cardiology; North American Society for Cardiovascular Imaging; Society for Cardiovascular Angiography and Interventions; Society for Cardiovascular Magnetic Resonance, Kramer CM, Berman D, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2010;56:1864–94.

    Article  PubMed  Google Scholar 

  20. ASCI CCT and CMR Guideline Working Group, Kitagawa K, Choi BW, Chan C, et al. ASCI 2010 appropriateness criteria for cardiac magnetic resonance imaging: a report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group. Int J Cardiovasc Imaging. 2010;26 Suppl 2:173–86.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Acampa W, Petretta M, Florimonte L, Mattera A, Cuocolo A. Prognostic value of exercise cardiac tomography performed late after percutaneous coronary intervention in symptomatic and symptom-free patients. Am J Cardiol. 2003;91:259–63.

    Article  PubMed  Google Scholar 

  22. Harb SC, Cook T, Jaber WA, Marwick TH. Exercise testing in asymptomatic patients after revascularization: are outcomes altered? Arch Intern Med. 2012;172:854–61.

    Article  PubMed  Google Scholar 

  23. Askew JW, Miller TD, Greason KL, et al. Population-based study of the use of cardiac stress imaging and referral for coronary angiography and repeated revascularization after coronary artery bypass graft surgery. Mayo Clin Proc. 2013;88:345–53. A community-based population assessing stress single-photon emission computed tomography use after coronary artery bypass grafting and the impact on referral for coronary angiography and revascularization.

    Article  PubMed  Google Scholar 

  24. Acampa W, Petretta MP, Daniele S, Perrone-Filardi P, Petretta M, Cuocolo A. Myocardial perfusion imaging after coronary revascularization: a clinical appraisal. Eur J Nucl Med Mol Imaging. 2013;40:1275–82.

    Article  CAS  PubMed  Google Scholar 

  25. Rassaf T, Steiner S, Kelm M. Postoperative care and follow-up after coronary stenting. Dtsch Arztebl Int. 2013;110:72–82.

    PubMed Central  PubMed  Google Scholar 

  26. Eisenberg MJ, Blankenship JC, Huynh T, et al. Evaluation of routine functional testing after percutaneous coronary intervention. Am J Cardiol. 2004;93:744–7.

    Article  PubMed  Google Scholar 

  27. Eisenberg MJ, Wilson B, Lauzon C, et al. Routine functional testing after percutaneous coronary intervention: results of the aggressive diagnosis of restenosis in high-risk patients (ADORE II) trial. Acta Cardiol. 2007;62:143–50.

    Article  PubMed  Google Scholar 

  28. Eisenberg MJ. Routine periodic stress testing in asymptomatic patients following coronary revascularization: is it worth the effort?: comment on "Exercise testing in asymptomatic patients after revascularization". Arch Intern Med. 2012;172:861–3.

    Article  PubMed  Google Scholar 

  29. Acampa W, Evangelista L, Petretta M, Liuzzi R, Cuocolo A. Usefulness of stress cardiac single-photon emission computed tomographic imaging late after percutaneous coronary intervention for assessing cardiac events and time to such events. Am J Cardiol. 2007;100:436–41.

    Article  PubMed  Google Scholar 

  30. Acampa W, Petretta M, Evangelista L, et al. Stress cardiac single-photon emission computed tomographic imaging late after coronary artery bypass surgery for risk stratification and estimation of time to cardiac events. J Thorac Cardiovasc Surg. 2008;136:46–51.

    Article  PubMed  Google Scholar 

  31. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124:e574–651.

    Article  PubMed  Google Scholar 

  32. Gibbons RJ, Balady GJ, Bricker JT, American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines), et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation. 2002;106:1883–92.

    Article  PubMed  Google Scholar 

  33. Song Y, Skinner J, Bynum J, Sutherland J, Wennberg JE, Fisher ES. Regional variations in diagnostic practices. N Engl J Med. 2010;363:45–53.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117:1283–91.

    Article  PubMed  Google Scholar 

  35. Sethi A, Bahekar A, Bhuriya R. Is appropriate use criteria for cardiac radionuclide imaging in asymptomatic diabetic patients evidence based? J Am Coll Cardiol. 2010;55:260. author reply 260–1.

    Article  PubMed  Google Scholar 

  36. Shaw LJ, Cerqueira MD, Brooks MM, et al. Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. J Nucl Cardiol. 2012;19:658–69. A large study demonstrating that a 1-year post-therapeutic intervention myocardial perfusion scan provides important information regarding prognosis in stable coronary artery disease patients with diabetes.

    Article  PubMed  Google Scholar 

  37. Zimarino M, Curzen N, Cicchitti V, De Caterina R. The adequacy of myocardial revascularization in patients with multivessel coronary artery disease. Int J Cardiol. 2013;168:1748–57.

    Article  PubMed  Google Scholar 

  38. Garcia S, Sandoval Y, Roukoz H, et al. Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies. J Am Coll Cardiol. 2013;62:1421–31. A systematic review and a large meta-analysis of studies comparing complete revascularization versus incomplete revascularization in patients with multivessel coronary artery disease.

    Article  PubMed  Google Scholar 

  39. Wu C, Dyer AM, King 3rd SB, et al. Impact of incomplete revascularization on long-term mortality after coronary stenting. Circ Cardiovasc Interv. 2011;4:413–21.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Farooq V, Serruys PW, Bourantas CV, et al. Quantification of incomplete revascularization and its association with five-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial validation of the residual SYNTAX score. Circulation. 2013;128:141–51.

    Article  CAS  PubMed  Google Scholar 

  41. Dauerman HL. Reasonable incomplete revascularization. Circulation. 2011;123:2337–40.

    Article  PubMed  Google Scholar 

  42. De Bruyne B. Multivessel disease: from reasonably incomplete to functionally complete revascularization. Circulation. 2012;125:2557–9.

    Article  PubMed  Google Scholar 

  43. Ong AT, Serruys PW. Complete revascularization: coronary artery bypass graft surgery versus percutaneous coronary intervention. Circulation. 2006;114:249–55.

    Article  PubMed  Google Scholar 

  44. Arnold JR, Karamitsos TD, van Gaal WJ, et al. Residual ischemia after revascularization in multivessel coronary artery disease: insights from measurement of absolute myocardial blood flow using magnetic resonance imaging compared with angiographic assessment. Circ Cardiovasc Interv. 2013;6:237–45.

    Article  PubMed  Google Scholar 

  45. Ranasinghe I. Dissemination of healthcare technologies: toward a more informed approach? Circ Cardiovasc Qual Outcomes. 2013;6:373–5.

    Article  PubMed  Google Scholar 

  46. Min JK, Kang N, Shaw LJ, Devereux RB, et al. Costs and clinical outcomes after coronary multidetector CT angiography in patients without known coronary artery disease: comparison to myocardial perfusion SPECT. Radiology. 2008;249:62–70.

    Article  PubMed  Google Scholar 

  47. Cheezum MK, Hulten EA, Taylor AJ, et al. Cardiac CT angiography compared with myocardial perfusion stress testing on downstream resource utilization. J Cardiovasc Comput Tomogr. 2011;5:101–9.

    Article  PubMed  Google Scholar 

  48. Min JK, Gilmore A, Budoff MJ, Berman DS, O'Day K. Cost-effectiveness of coronary CT angiography versus myocardial perfusion SPECT for evaluation of patients with chest pain and no known coronary artery disease. Radiology. 2010;254:801–8.

    Article  PubMed  Google Scholar 

  49. Mudrick D, Kaltenbach LA, Shah B, et al. Downstream testing and subsequent procedures after coronary computed tomographic angiography following coronary stenting in patients ≥65 years of age. Am J Cardiol. 2012;110:776–83.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Carrabba N, Schuijf JD, de Graaf FR, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography for the detection of in-stent restenosis: a meta-analysis. J Nucl Cardiol. 2010;17:470–8.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Haraldsdottir S, Gudnason T, Sigurdsson AF, et al. Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population. Eur J Radiol. 2010;76:188–94.

    Article  PubMed  Google Scholar 

  52. Mudrick DW, Shah BR, McCoy LA, et al. Patterns of stress testing and diagnostic catheterization after coronary stenting in 250 350 medicare beneficiaries. Circ Cardiovasc Imaging. 2013;6:11–9.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Shah BR, McCoy LA, Federspiel JJ, et al. Use of stress testing and diagnostic catheterization after coronary stenting: association of site-level patterns with patient characteristics and outcomes in 247,052 Medicare beneficiaries. J Am Coll Cardiol. 2013;62:439–46.

    Article  PubMed  Google Scholar 

  54. Dorbala S, Di Carli MF, Delbeke D, et al. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J Nucl Med. 2013;54:1485–507.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Mario Petretta, Renato Cuocolo, Wanda Acampa, and Alberto Cuocolo declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mario Petretta.

Additional information

This article is part of the Topical Collection on Cardiac Nuclear Imaging

Rights and permissions

Reprints and permissions

About this article

Cite this article

Petretta, M., Cuocolo, R., Acampa, W. et al. Cardiac Radionuclide Imaging After Coronary Artery Revascularization. Curr Cardiovasc Imaging Rep 7, 9255 (2014). https://doi.org/10.1007/s12410-013-9255-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s12410-013-9255-8

Keywords

Navigation