Prognostic characterization of patients with mild coronary artery disease with myocardial perfusion single photon emission computed tomography: Validation of an outcomes-based strategy
Editorials
Conclusion
The emergence of this exciting new shift in the potential application of nuclear testing, a risk-based approach permitting the indentification of patients with mild CAD not in need of aggressive treatment, permits us not only to spare patients the risk and inconvenience of additional testing but also to better manage the available resources. O'Keefe et al.29 are to be commended for pointing our a means to enhance patient care and to achieve both clinical and cost-effectiveness.
Preview
Unable to display preview. Download preview PDF.
References
- 1.Rutherford JD, Braunwald E. Chronic ischemic heart disease. In: Braunwald E, editor. Heart disease. Philadelphia: WB Saunders, 1992. p. 1293–364.Google Scholar
- 2.CASS principle investigators and their associates. Myocardial infarction and mortality in the Coronary Artery Surgery Study (CASS) randomized trial. N Engl J Med 1984;310:750–8.Google Scholar
- 3.Alderman EL, Bourassa MG, Cohen LS, Davis KB, Kaiser GG, Killip T, et al. Ten-year follow-up of survival and myocardial infarction in the randomized Coronary Artery Surgery Study. Circulation 1990;82:1629–46.PubMedGoogle Scholar
- 4.Detre KM, Takaro P, Hultgren H, Peduzzi P, and the study participants. Long term mortality and morbidity results of the Veterans Administration randomized trial of coronary artery by-pass surgery. Circulation 1985;72(suppl V):V84–9.PubMedGoogle Scholar
- 5.Varnauskas E and the European Coronary Surgery Study Group. Survival, myocardial infarction, and employment status in a prospective randomized study of coronary bypass surgery. Circulation 1985;72(suppl V):V90–101.PubMedGoogle Scholar
- 6.The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group. Eighteen year follow up in the Veterans Administration Cooperative Study of Coronary Artery Bypass Surgery for stable angina. Circulation 1992;86:121–30.Google Scholar
- 7.Myers WO, Schaff HV, Fisher LD, Marshfield WI, Gersh BJ. Time to first new myocardial infarction in patients with severe angina and three vessel disease comparing early medical and surgical therapy: a CASS registry study of survival. J Thorac Cardiovasc Surg 1988;95:382–95.PubMedGoogle Scholar
- 8.Yusuf S, Zucker D, Peduzzi P, Takaro T, Kennedy JW, Davis K, et al. Effect of coronary artery bypass surgery on survival: overview of 10-year results from randomized trials by the Coronary Artery Bypass Surgery Trialists Collaboration. Lancet 1994; 344:563–70.PubMedCrossRefGoogle Scholar
- 9.Takaro T, Peduzzi P, Detre K, Hultgren H, Murphy ML, Van Der Bel-Kahn J et al. Survival in subgroups of patients with left main coronary disease: Veterans Administration cooperative study of surgery for coronary arterial occlusive disease. Circulation 1982; 66:14–22.PubMedGoogle Scholar
- 10.European coronary surgery study group. Long term results of prospective randomized study of coronary artery bypass in stable angina pectoris. Lancet 1982;2:1173–80.Google Scholar
- 11.Maddahi J, Rodrigues E, Kiat H, Van Train KF, Berman DS. Detection and evaluation of cad by thallium-201 myocardial perfusion scintigraphy. In: DePuey EG, Berman DS, Garcia EV, editors. Cardiac SPECT imaging. Philadelphia: Lippincott-Raven; 1996. p. 103–20.Google Scholar
- 12.Berman DS, Kiat H, Germano G, Van Train KF, Maddahi J, DePuey EG, et al. 99m-Tc-sestamibi SPECT. In: DePuey EG, Berman DS, Garcia EV, editors. Cardiac SPECT imaging. Philadelphia: Lippincott-Raven; 1996; p. 121–46.Google Scholar
- 13.Diamond GA, Staniloff HM, Forrester JS, Pollock BH, Swan HJC. Computer-assisted diagnosis in the evaluation of patients with suspected coronary artery disease. J Am Coll Cardiol 1983;1:444–55.PubMedGoogle Scholar
- 14.Miller DD, Heller G, Travin M, Kesler K, Delong E, Eisenstein E, et al. Economic study of noninvasive economics group: a multicenter study of 2,737 patients examining the multivariate prognostic value of stress single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy (abstract). J Am Coll Cardiol 1996;27:286A.CrossRefGoogle Scholar
- 15.Ladenheim M, Kotler T, Pollock B, Berman DS, Diamond G. Incremental prognostic power of clinical history, exercise electrocardiography and myocardial perfusion scintigraphy in suspected coronary artery disease. Am J Cardiol 1987;59:270–7.PubMedCrossRefGoogle Scholar
- 16.Kaul S, Finkelstein DM, Homma S, Leavitt M, Okada RD, Boucher CA. Superiority of quantitative exercise thallium-201 variables in determining long-term prognosis in ambulatory patients with chest pain: a comparison with cardiac catheterization. J Am Coll Cardiol 1988;12:25–34.PubMedCrossRefGoogle Scholar
- 17.Kaul S, Lilly DR, Gascho JA, Watson DD, Gibson RS, Oliner CA, et al. Prognostic utility of the exercise thallium-201 test in ambulatory patients with chest pain: comparison with cardiac catheterization. Circulation 1988;77:745–58.PubMedGoogle Scholar
- 18.Machecourt J, Longere P, Fagret D, Vanzetto G, Wolf JE, Polidori C, et al. Prognostic value of thallium-201 single-photon emission computed tomographic myocardial perfusion imaging according to extent of myocardial defect: study in 1,926 patients with follow up at 33 months. J Am Coll Cardiol 1994;23:1096–106.PubMedGoogle Scholar
- 19.Iskandrian AS, Chae SC, Heo J, Stanberry CD, Wasserleben V, Cave V. Independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in coronary artery disease. J Am Coll Cardiol 1993;22:665–70.PubMedGoogle Scholar
- 20.Strattman HG, Williams GA, Wittry MD, Chaitman BR, Miller DD. Exercise technetium 99-m sestamibi tomography for cardiac risk stratification of patients with stable chest pain. Circulation 1994;89:615–22.Google Scholar
- 21.Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, et al. Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and impact on subsequent patient management. Circulation 1996;93:905–14.PubMedGoogle Scholar
- 22.Berman DS, Hachamovitch R, Kiat H, Cohen I, Cabico A, Wang FP, et al. Incremental prognostic value and cost implications of normal and equivocal exercise Tc-99m sestamibi myocardial perfusion SPECT. J Am Coll Cardiol 1995;26:639–47.PubMedCrossRefGoogle Scholar
- 23.Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. The prediction of myocardial infarction versus cardiac death by myocardial perfusion SPECT: strategic and therapeutic implications. Circulation (in press).Google Scholar
- 24.Brown KA. Prognostic value of thallium-201 myocardial perfusion imaging: a diagnostic tool comes of age. Circulation 1991;83:363–81.PubMedGoogle Scholar
- 25.Hachamovitch R, Berman DS, Morise AP, Diamond GA. Statistical, epidemiological and fiscal issues in the evaluation of patients with coronary artery disease. Q J Nucl Med 1996;40:35–46.PubMedGoogle Scholar
- 26.Shaw LJ, Kesler K, Eisenstein E, Heller GV, Travin MI, Duca MD, et al. A multicenter study of 11,372 patients to examine cost-effective strategies for diagnosis of coronary artery disease. J Am Coll Cardiol 1996;27:286A.CrossRefGoogle Scholar
- 27.Shaw LJ, Hachamovitch R, Marwick TH, Heller GV, Travin MI, Borges-Neto S, et al. Does the use of noninvasive testing reduce short- and long-term costs of care? Circulation 1996;94:I-20.Google Scholar
- 28.Hachamovitch R, Berman DS, Kiat H, Shaw LJ, Cohen I, Friedman J, et al. SPECT in patients with normal rest ECG: incremental prognostic value and enhanced risk classification. J Nucl Med 1996;37:116P.Google Scholar
- 29.O'Keefe JH, Bateman TM, Ligon RW, Case J, Cullom J, Spertus J. Outcome of medical versus invasive treatment strategies for non-high risk ischemic heart disease. J Nucl Cardiol 1998;5:28–33.PubMedCrossRefGoogle Scholar
- 30.Braunwald E, Mark DB, Jones RH, et al. Clinical practice guideline number 10: unstable angina: diagnosis and management. U.S. DHHS, PHS, Washington, DC. AHCPR Publication No. 94-0602.Google Scholar
- 31.Kloster FE, Kremkau EL, Ritzmann SH, Rahimtoola SH, Rosch J, Kanarck PH. Coronary bypass for stable angina: a prospective randomized study. N Engl J Med 1979;300:149–57.PubMedGoogle Scholar
- 32.Mathur VS, Guinn GA. Prospective randomized trial of the surgical therapy of angina. Cardiovasc Clin 1977;8:131–44.PubMedGoogle Scholar
- 33.Manson JE, Stampfer MJ, Colditz GA, Willet WC, Rosner B, Speizer FE, et al. A prospective trial of aspirin use and primary prevention of cardiovascular disease in women. JAMA 1991;265:521–7.CrossRefGoogle Scholar
- 34.The steering committee of the physicians’ health study research group. Preliminary report: findings from the aspirin component of the ongoing physicians’ health study. N Engl J Med 1988;318:262–4.Google Scholar
- 35.Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994;344:1383–9.CrossRefGoogle Scholar
- 36.Shepard J, Cobbie SM, Ford I, Ford I, Isles CG, Lorimer AR, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995;333:1301–7.CrossRefGoogle Scholar
- 37.Harris PJ, Lee KL, Harrell, Jr, FE, Behar VS, Rosati RA. Outcome in medically treated coronary artery disease. Ischemic events: nonfatal infarction and death. Circulation 1980;62:718–26.PubMedGoogle Scholar
- 38.Shaw LJ, Hachamovitch R, Eisenstein E, Kesler K, Heller GV, Miller DD. Biostatistic and economic principles for diagnostic and prognostic modeling in nuclear cardiology: Part I. J Nucl Cardiol 1996;3:538–45.PubMedCrossRefGoogle Scholar
- 39.Shaw LJ, Eisenstein E, Hachamovitch R, Berman DS, Heller GV, Miller DD, for the Economics of Noninvasive Diagnosis Multicenter and Duke Noninvasive Research Working Groups. Biostatistic and economic principles for diagnostic and prognostic modeling in nuclear cardiology: Part II. J Nucl Cardiol 1996;4:52–60.CrossRefGoogle Scholar
- 40.Harrell FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996;15:361–87.PubMedCrossRefGoogle Scholar
- 41.Shaw LJ, Hachamovitch R, Heller GV, Marwick TH, Kesler K, Lauer MS, et al. Regional variation in rates of cardiac catheterization in stable angina patients undergoing myocardial perfusion imaging. J Am Coll Cardiol 1997;29:349A.Google Scholar
Copyright information
© American Society of Nuclear Cardiology 1998