Temporal trends of single-photon emission computed tomography myocardial perfusion imaging in patients without prior coronary artery disease: A 22-year experience at a tertiary academic medical center.
Between 1990 and 2006, there was a large national increase in utilization of single-photon emission computed tomography myocardial perfusion imaging (SPECT) for assessment of coronary artery disease (CAD). We aim to examine the trends of SPECT test results and patients' characteristics at Mayo Clinic Rochester.



Using the Mayo Clinic nuclear cardiology database, we examined all SPECT tests performed between January 1, 1991, and December 31, 2012, in patients without prior CAD. The study cohort was divided into 5 time periods: 1991-1995, 1996-2000, 2001-2005, 2006-2010, and 2011-2012.



There were 35,894 eligible SPECT tests (mean age 62.5 ± 12 years, 54% men). Annual utilization of SPECT increased significantly in 1992-2002 but then decreased without evidence of test substitution with stress echocardiography. There were modest changes in CAD risk factors over time. Testing of asymptomatic patients doubled (21.9% in 1991-1995 to 40% in 2006-2010) but later decreased to 33.6% in 2011-2012. Tests on patients with typical angina decreased dramatically (18.3% in 1991-1995 to 6.7% in 2011-2012). Summed stress score, summed difference score, and high-risk SPECT tests all decreased over time in both symptomatic and asymptomatic patients regardless of stress modality (exercise vs pharmacologic).



In Mayo Clinic Rochester, annual SPECT utilization in patients without prior CAD increased in 1992-2002 but then decreased. Despite similar CAD risk factors and decreased utilization after 2003, more tests were low risk; summed stress score, summed difference score, and high-risk tests all decreased. Our findings confirm previous observations that SPECT was increasingly used in patients with a lower prevalence of CAD.
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Hayan
H
Jouni
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
J Wells
JW
Askew
Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Daniel J
DJ
Crusan
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Todd D
TD
Miller
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address: Gibbons.Raymond@mayo.edu.
Raymond J
RJ
Gibbons
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods / Q000639:trends; D010043:Outcome and Process Assessment, Health Care; D020379:Risk Adjustment / Q000639:trends*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology