(13)N-ammonia myocardial perfusion imaging with a PET/CT scanner: impact on clinical decision making and cost-effectiveness.
OBJECTIVE
The purpose of the study is to determine the impact of 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI) on clinical decision making and its cost-effectiveness.


METHODS
One hundred consecutive patients (28 women, 72 men; mean age 60.9 +/- 12.0 years; range 24-85 years) underwent 13N-ammonia PET scanning (and computed tomography, used only for attenuation correction) to assess myocardial perfusion in patients with known (n = 79) or suspected (n = 8) coronary artery disease (CAD), or for suspected small-vessel disease (SVD; n = 13). Before PET, the referring physician was asked to determine patient treatment if PET would not be available. Four weeks later, PET patient management was reassessed for each patient individually.


RESULTS
Before PET management strategies would have been: diagnostic angiography (62 of 100 patients), diagnostic angiography and percutaneous coronary intervention (PCI; 6 of 100), coronary artery bypass grafting (CABG; 3 of 100), transplantation (1 of 100), or conservative medical treatment (28 of 100). After PET scanning, treatment strategies were altered in 78 patients leading to: diagnostic angiography (0 of 100), PCI (20 of 100), CABG (3 of 100), transplantation (1 of 100), or conservative medical treatment (76 of 100). Patient management followed the recommendations of PET findings in 97% of the cases. Cost-effectiveness analysis revealed lower costs of <euro>206/patient as a result of PET scanning.


CONCLUSIONS
In a population with a high prevalence of known CAD, PET is cost-effective and has an important impact on patient management.
Cardiovascular Center, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
Patrick T
PT
Siegrist
Lars
L
Husmann
Martina
M
Knabenhans
Oliver
O
Gaemperli
Ines
I
Valenta
Tobias
T
Hoefflinghaus
Hans
H
Scheffel
Paul
P
Stolzmann
Hatem
H
Alkadhi
Philipp A
PA
Kaufmann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000641:Ammonia / Q000191:economics*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009587:Nitrogen Isotopes / Q000191:economics; D049268:Positron-Emission Tomography / Q000191:economics* / Q000295:instrumentation* / Q000706:statistics & numerical data; D015995:Prevalence; D019275:Radiopharmaceuticals / Q000191:economics; D013382:Subtraction Technique / Q000191:economics / Q000295:instrumentation / Q000706:statistics & numerical data; D013557:Switzerland / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000295:instrumentation* / Q000706:statistics & numerical data
D009587:Nitrogen Isotopes; D019275:Radiopharmaceuticals; D000641:Ammonia