title: Clinical utility of inappropriate positron emission tomography myocardial perfusion imaging: test results and cardiovascular events.
abstract: BACKGROUND
  Appropriate use criteria for myocardial perfusion imaging (MPI) were developed to categorize scenarios where MPI might be beneficial (appropriate) or not (inappropriate). Few investigations have evaluated the clinical utility of this categorization strategy, particularly with positron emission tomography (PET) MPI.
  
  
  RESULTS
  We conducted this retrospective cohort investigation in a Veterans Affairs (VA) medical center, on predominantly male subjects who underwent PET-MPI. We correlated appropriateness to test result and cardiovascular events. Of 521 subjects, 414 (79.5%) were appropriate, 54 (10.4%) were uncertain, and 53 (10.2%) were inappropriate. PET-MPI was abnormal more often when appropriate or uncertain (28% and 34.6%, respectively, vs 7.7% for inappropriate, P = .003). Among abnormal inappropriate tests, none detected occult ischemia. By Cox regression, summed difference score ≥5 (HR 5.06, 95% CI 2.72-9.44) and an abnormal test result (HR 4.48, 95% CI 2.19-9.14) were associated with higher likelihood of catheterization. Log-rank analysis demonstrated similar likelihood of catheterization when comparing abnormal vs normal test result (P < .0001) and between appropriate, uncertain, and inappropriate tests (P = .024).
  
  
  CONCLUSIONS
  Inappropriate PET-MPI was rarely abnormal, associated with low catheterization rates, and failed to detect occult ischemia for any subjects. The clinical utility of inappropriate PET-MPI is negligible.
authors.affiliation: Malcom Randall VA Medical Center; College of Medicine, University of Florida, Gainesville, FL, USA. david.winchester@va.gov
authors.forename: David E
authors.initials: DE
authors.lastname: Winchester
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Chauffe
authors.forename: Ryan
authors.initials: R
authors.lastname: Meral
authors.forename: Daniel
authors.initials: D
authors.lastname: Nguyen
authors.forename: Scott
authors.initials: S
authors.lastname: Ryals
authors.forename: Raman
authors.initials: R
authors.lastname: Dusaj
authors.forename: Leslee
authors.initials: L
authors.lastname: Shaw
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Beyth
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D049268:Positron-Emission Tomography; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
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