Indication of myocardial perfusion scintigraphy for coronary artery disease detection based on clinical-epidemiological and treadmill test evidences.
OBJECTIVE
To establish when the myocardial perfusion scintigraphy (MPS) should be performed based on well-defined information obtained from treadmill test results and clinical-epidemiological parameters for coronary artery disease (CAD).


METHODS
2,100 patients who underwent MPS were classified according to the results of scintigraphy, the Duke score and a clinical-epidemiological score based on Framingham study. The patients with positive results on MPS were followed to define whether the results were true positives. Receiver operating characteristic (ROC) curves were used to establish the efficiency and the best Duke and clinical-epidemiological scores to define patients that should be submitted to scintigraphy.


RESULTS
It was observed that the MPS use restriction in patients with Duke score below 7.5 and/or clinical-epidemiological score above 4 could decrease the utilization of this method by 50% without exposing the patients to a significant misdiagnosis risk.


CONCLUSIONS
The utilization of the Duke score and a clinical-epidemiological score to classify the patients expressively decreased the number of unnecessarily requested scintigraphies.
Duarte
Paulo Schiavom
PS
Faculdade de Saúde Pública, USP, São Paulo, SP, Brazil. paulo.duarte@fleury.com.br
Mastrocolla
Luiz Eduardo
LE
Sampaio
Célia Regina E P S
CR
Rossi
João Manoel
JM
Smanio
Paola Emanuela
PE
Martins
Luiz Roberto Fernandes
LR
Pereira
Júlio César Rodrigues
JC
D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010477:Perfusion; D011237:Predictive Value of Tests; D012372:ROC Curve; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017256:Technetium Tc 99m Sestamibi
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi