title: Nuclear scans: a clinical decision making tool that reduces the need for cardiac catheterization.
abstract: We have assessed the impact of cardiovascular nuclear medicine studies (CVNMS) on physicians' decisions to send patients with suspected ischemic heart disease (N = 439) on to cardiac catheterization at three Bronx hospitals. A change in management plans with respect to catheterization was observed in 31% of cases. Catheterization rates were reduced by 25% among patients referred for resting studies and by 49% for exercise studies (thallium perfusion or exercise wall motion studies). Results of CVNMS had little impact on catheterization decisions for resting study patients (N = 192). Among exercise study patients (N = 247), those with normal results had a relative reduction in catheterization post-CVNMS of 82% vs 27% for patients with abnormal results (p less than 0.001). However, impact of exercise CVNMS test results on post-CVNMS catheterization rates obtained for men only; women with abnormal exercise study results were much less likely to undergo subsequent catheterization (7.7%) than men with abnormal results (41.9%), p less than 0.005, independent of age. The apparent discrepancy in referral for catheterization based on sex needs to be investigated further.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003657:Decision Making; D005069:Evaluation Studies as Topic; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011868:Radioisotopes; D011877:Radionuclide Imaging; D012017:Referral and Consultation; D012044:Regression Analysis; D012737:Sex Factors; D013793:Thallium
chemical_list: D011868:Radioisotopes; D013793:Thallium