title: Downstream clinical implications of abnormal myocardial perfusion single-photon emission computed tomography based on appropriate use criteria.
abstract: BACKGROUND
  Appropriate use criteria (AUC) for single-photon emission computed tomography myocardial perfusion images (SPECT-MPI) were developed to address the growth of cardiac imaging studies. However, these criteria have not been vigorously validated. We sought to determine the rate of abnormal stress SPECT-MPI studies and subsequent revascularization procedures as categorized by AUC.
  
  
  METHODS
  We retrospectively examined 280 patients who underwent stress SPECT-MPI and categorized these studies as appropriate, inappropriate, or uncertain based on AUC. Data regarding subsequent angiography and revascularization within 6 months after stress SPECT-MPI were collected from the electronic medical record.
  
  
  RESULTS
  280 patients met the inclusion criteria (mean age 67.3 ± 11.4 years, 36 % female). When categorized by AUC, 62.9 % (N = 176) of stress SPECT-MPI were considered appropriate, 13.6 % (N = 38) uncertain, and 23.6 % (N = 66) inappropriate. Appropriate stress SPECT-MPI studies were more likely to have intermediate or high risk results than uncertain or inappropriate studies [40 % (N = 71) vs. 21 % (N = 8) and 18 % (N = 12), respectively; P = 0.008)]. Appropriate studies were associated with an increased rate of coronary angiography [14 % (N = 25)] compared to the uncertain (0 %) and inappropriate [3 % (N = 2)] studies (P = 0.003). There was also an increased rate of revascularization after appropriate studies [9 % (N = 16)] compared to the uncertain (0 %) and inappropriate (0 %) studies (P = 0.006).
  
  
  CONCLUSIONS
  Appropriate stress SPECT-MPI studies are more likely to result in abnormal results requiring subsequent revascularization compared to inappropriate and uncertain stress studies. Inappropriate and uncertain stress SPECT-MPI did not lead to subsequent revascularization.
authors.affiliation: Center for Interventional Vascular Therapy, Division of Cardiovascular Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Farhan J
authors.initials: FJ
authors.lastname: Khawaja
authors.forename: Hayan
authors.initials: H
authors.lastname: Jouni
authors.forename: Todd D
authors.initials: TD
authors.lastname: Miller
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Gibbons
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon