Follow-up SPECT myocardial perfusion imaging scans performed infrequently in patients without prior CAD

Carryer D. Circ Cardiovasc Imaging. 2010;3:520-526.

Issue: November 2010

Routine follow-up of single-photon emission CT myocardial perfusion imaging was performed infrequently in patients without prior coronary artery disease, whereas the rate was twofold higher in patients with previous coronary artery disease, study data suggested.

The study included patients from the Mayo Clinic in Rochester, Minn., who had normal stress SPECT scans in 2002. Patients were excluded if they did not grant research authorization in accordance with Minnesota state law, had any fixed defect greater than what was considered mild and had any reversible defect.

Of the 2,354 patients identified as having no prior CAD, 449 (19%) had follow-up scans, with 309 (13%) having routine follow-up scans. The median time for follow-up was 2.1 years, with only 64 patients (21%) having a follow-up scan after the time to 1% risk for death or MI (ie, warranty period; median, 5.5 years).

In patients with prior CAD (n=656), 39% (n=259) had follow-up scans, with 26% (n=171) having routine scans. The median time for follow-up was 1.6 years, which, conversely to the patients without CAD, was longer than the warranty period (0.9 years).

Regarding the opportunity for improvement that was revealed by this data, the researchers said many of the cardiologists and non-cardiologists ordering SPECT myocardial perfusion imaging may be unaware or unfamiliar with appropriateness criteria or the concept of a warranty period after a normal stress SPECT myocardial perfusion imaging study. “Better physician education may result in more effective use of nuclear imaging resources, improved patient care and decreased costs,” they wrote. “Incorporating the science of a warranty period into appropriateness criteria ratings may strengthen their effectiveness.”

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