title: A multicenter evaluation of the appropriate use of single-photon emission tomography myocardial perfusion imaging in Greece.
abstract: BACKGROUND
  This study evaluates the appropriate use of myocardial perfusion imaging (MPI) and determines patterns and variables associated with inappropriate testing.
  
  
  METHODS
  Over a 10-month period data were collected prospectively from consecutive patients referred for MPI in four academic departments and an appropriate use grade was assigned (appropriate, uncertain, inappropriate, and unclassifiable scans) according to established criteria.
  
  
  RESULTS
  Among 3,032 referrals appropriate MPI had 72.8% of patients and 19.2% of studies were inappropriate, the remaining being uncertain (7.2%) or unclassifiable (0.8%). In multivariate analysis the asymptomatic status (odds ratio 10.7, P < .001), good functional capacity (odds ratio 1.9, P < .001), an interpretable resting electrocardiogram (odds ratio 1.8, P = .004), an age <65 years (odds ratio 1.5, P = .001) and the absence of diabetes (odds ratio 1.7, P < .001) or dyslipidemia (odds ratio 1.3, P = .014) were independent predictors of inappropriate scintigraphy. The most common indication for inappropriate testing was the assessment of asymptomatic patients <2 years after percutaneous coronary intervention (PCI) (38.9%).
  
  
  CONCLUSIONS
  The appropriate use of MPI is relatively high, but a considerable proportion of inappropriate scans is noted which is associated with markers of lower risk. The most common source of inappropriate testing is the assessment of asymptomatic patients <2 years after PCI.
authors: Department of Nuclear Medicine, AHEPA University Hospital, Aristotle University Medical School, 1 Stilponos Kyriakidi Str, 54636, Thessaloníki, Greece. emoral@hol.gr
authors: Efstratios
authors: E
authors: Moralidis
authors: Nafsika
authors: N
authors: Papadimitriou
authors: Maria
authors: M
authors: Stathaki
authors: Xanthi
authors: X
authors: Xourgia
authors: Tryfon
authors: T
authors: Spyridonidis
authors: Andreas
authors: A
authors: Fotopoulos
authors: Dimitrios
authors: D
authors: Apostolopoulos
authors: Nikolaos
authors: N
authors: Karkavitsas
authors: Anna
authors: A
authors: Gotzamani-Psarrakou
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review