title: Outcomes after inappropriate nuclear myocardial perfusion imaging: A meta-analysis.
abstract: The relationship between inappropriate MPI and cardiovascular outcomes is poorly understood. We sought to systematically review the literature on appropriate use criteria (AUC) for MPI, including temporal trend of inappropriate testing and resulting cardiovascular outcomes.
  
  
  
  We searched the MEDLINE database for studies related to AUC and MPI. The co-primary outcomes were abnormal test results and the presence of cardiac ischemia. Random effects odds ratios (OR) were constructed using DerSimonian-Laird method.
  
  
  
  A total of 22 studies with 23,443 patients were included. The prevalence of inappropriate testing was 14.8% [95% confidence interval (CI) 11.6%-18.7%]. Inappropriate MPI studies were less likely to be abnormal (OR 0.41 95% CI 0.35-0.49, P < .0001) and to demonstrate ischemia (OR 0.40, 95% CI 0.24-0.67, P < .0001) compared to appropriate testing. No difference in the rate of inappropriate tests was detected based on the midpoint of the enrollment year (P = .54). The pattern of ordering inappropriate studies was not different between cardiology and non-cardiology providers (OR 0.74, 95% CI 0.51-1.06, P = .10).
  
  
  
  Inappropriate MPI studies are less likely to yield abnormal results or demonstrate myocardial ischemia. The rate of inappropriate MPI has not decreased over time.
authors.affiliation: Division of Cardiovascular Medicine, University of Florida College of Medicine, 1600 SW Archer Rd, PO Box 100277, Gainesville, FL, 32610, USA.
authors.forename: Islam Y
authors.initials: IY
authors.lastname: Elgendy
authors.affiliation: Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mahmoud
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Shuster
authors.affiliation: Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Doukky
authors.affiliation: Division of Cardiovascular Medicine, University of Florida College of Medicine, 1600 SW Archer Rd, PO Box 100277, Gainesville, FL, 32610, USA. david.winchester@medicine.ufl.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Winchester
mesh_terms: D000368:Aged; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016239:MEDLINE / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000453:epidemiology*; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data* / Q000639:trends*; D014600:Utilization Review
keywords: Myocardial perfusion imaging; PET; SPECT; ischemia; myocardial