Differential Impact of Appropriate Use Criteria on the Association between Age and Abnormal Stress Myocardial Perfusion SPECT
Methods: We analyzed a multisite prospective cohort of 1511 consecutive patients (age 59±13 years, 57% males) who underwent outpatient, community-based single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Appropriateness of the studies was determined on the basis of the 2013 multimodality AUC for detection and risk assessment of stable ischemic heart disease. Abnormal SPECT MPI was defined by either a summed stress score of 4 or greater or a summed difference score of 2 or greater.
Results: Abnormal SPECT MPI was present in 190 patients (12.5%), while ischemia on MPI alone was present in 122 patients (8%). In multivariate logistic regression analysis, age of 60 years or greater, male sex, hypertension, diabetes mellitus, and known CAD were independent predictors of abnormal SPET MPI, while appropriate indication for testing was not. Age of 60 years or greater was also an independent predictor of inducible myocardial ischemia, while appropriate indication for testing was not. Among the elderly (≥60 years), regardless of appropriateness of testing, there was no difference in the prevalence of abnormal SPECT (19 vs. 14%, P=0.14) or prevalence of SPECT ischemia (11 vs. 11%, P=1.00). Among younger patients, however, appropriate testing predicted a greater prevalence of abnormal SPECT (12 vs. 7%, P=0.013).
Conclusion: In this multisite cohort, testing based on AUC did not discriminate the risk of abnormal SPECT MPI among the elderly. Caution is advised when relying on AUC for referral of elderly patients for SPECT MPI.
Document Type: Research Article
Publication date: April 1, 2019
This article was made available online on February 7, 2019 as a Fast Track article with title: "Differential Impact of Appropriate Use Criteria on the Association between Age and Abnormal Stress Myocardial Perfusion SPECT".
Cardiovascular Innovations and Applications (CVIA) publishes focused articles and original clinical research that explore novel developments in cardiovascular disease, effective control and rehabilitation in cardiovascular disease, and promote cardiovascular innovations and applications for the betterment of public health globally. The journal publishes basic research that has clinical applicability in order to promote timely communication of the latest insights relating to coronary artery disease, heart failure, hypertension, cardiac arrhythmia, prevention of cardiovascular disease with a heavy emphasis on risk factor modification. Cardiovascular Innovations and Applications is the official journal of the Great Wall International Congress of Cardiology (GW-ICC). It aims to continue the work of the GW-ICC by providing a global scientific communication platform for cardiologists that bridges East and West.
- Editorial Board
- Information for Authors
- Submit a Paper
- Subscribe to this Title
- Membership Information
- Information for Advertisers
- Terms & Conditions
- Ingenta Connect is not responsible for the content or availability of external websites