title: Indication of myocardial perfusion scintigraphy for coronary artery disease detection based on clinical-epidemiological and treadmill test evidences.
abstract: 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.
authors.affiliation: Faculdade de Saúde Pública, USP, São Paulo, SP, Brazil. paulo.duarte@fleury.com.br
authors.forename: Paulo Schiavom
authors.initials: PS
authors.lastname: Duarte
authors.forename: Luiz Eduardo
authors.initials: LE
authors.lastname: Mastrocolla
authors.forename: Célia Regina E P S
authors.initials: CR
authors.lastname: Sampaio
authors.forename: João Manoel
authors.initials: JM
authors.lastname: Rossi
authors.forename: Paola Emanuela
authors.initials: PE
authors.lastname: Smanio
authors.forename: Luiz Roberto Fernandes
authors.initials: LR
authors.lastname: Martins
authors.forename: Júlio César Rodrigues
authors.initials: JC
authors.lastname: Pereira
mesh_terms: 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
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi