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Myocardial perfusion scintigraphy: the evidence.

Underwood SR, Anagnostopoulos C, Cerqueira M, Ell PJ, Flint EJ, Harbinson M, Kelion AD, Al-Mohammad A, Prvulovich EM, Shaw LJ, Tweddel AC, British Cardiac SocietyBritish Nuclear Cardiology SocietyBritish Nuclear Medicine SocietyRoyal College of Physicians of LondonRoyal College of Radiologis - Eur. J. Nucl. Med. Mol. Imaging (2004)

Bottom Line: This in turn allows more appropriate utilisation of resources, with the potential for both improved clinical outcomes and greater cost-effectiveness.Evidence from modelling and observational studies supports the enhanced cost-effectiveness associated with MPS use.In patients presenting with stable or acute chest pain, strategies of investigation involving MPS are more cost-effective than those not using the technique.

View Article: PubMed Central - PubMed

Affiliation: Imperial College London, Royal Brompton Hospital, London, UK. r.underwood@imperial.ac.uk

ABSTRACT
This review summarises the evidence for the role of myocardial perfusion scintigraphy (MPS) in patients with known or suspected coronary artery disease. It is the product of a consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society and is endorsed by the Royal College of Physicians of London and the Royal College of Radiologists. It was used to inform the UK National Institute of Clinical Excellence in their appraisal of MPS in patients with chest pain and myocardial infarction. MPS is a well-established, non-invasive imaging technique with a large body of evidence to support its effectiveness in the diagnosis and management of angina and myocardial infarction. It is more accurate than the exercise ECG in detecting myocardial ischaemia and it is the single most powerful technique for predicting future coronary events. The high diagnostic accuracy of MPS allows reliable risk stratification and guides the selection of patients for further interventions, such as revascularisation. This in turn allows more appropriate utilisation of resources, with the potential for both improved clinical outcomes and greater cost-effectiveness. Evidence from modelling and observational studies supports the enhanced cost-effectiveness associated with MPS use. In patients presenting with stable or acute chest pain, strategies of investigation involving MPS are more cost-effective than those not using the technique. MPS also has particular advantages over alternative techniques in the management of a number of patient subgroups, including women, the elderly and those with diabetes, and its use will have a favourable impact on cost-effectiveness in these groups. MPS is already an integral part of many clinical guidelines for the investigation and management of angina and myocardial infarction. However, the technique is underutilised in the UK, as judged by the inappropriately long waiting times and by comparison with the numbers of revascularisations and coronary angiograms performed. Furthermore, MPS activity levels in this country fall far short of those in comparable European countries, with about half as many scans being undertaken per year. Currently, the number of MPS studies performed annually in the UK is 1,200/million population/year. We estimate the real need to be 4,000/million/year. The current average waiting time is 20 weeks and we recommend that clinically appropriate upper limits of waiting time are 6 weeks for routine studies and 1 week for urgent studies.

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Hard event rates over a mean of 15 months after myocardial infarction according to the number of segments with inducible ischaemia by MPS. Patients with more extensive ischaemia are at progressively higher risk (P=0.017). (From reference [248])
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Fig4: Hard event rates over a mean of 15 months after myocardial infarction according to the number of segments with inducible ischaemia by MPS. Patients with more extensive ischaemia are at progressively higher risk (P=0.017). (From reference [248])

Mentions: Travin and colleagues used MPS in 134 patients within 14 days of uncomplicated infarction and showed that the extent of ischaemia was the only significant predictor of future cardiac events on Cox regression analysis (Fig. 4) [248]. Similarly, Basu and colleagues in the UK showed a hazard ratio of 8.1 (95% CI 2.7–23.8, P<0.001) for coronary events comparing patients with and without inducible perfusion abnormalities [249]. Patients with no evidence of inducible ischaemia within the infarct zone, even in the presence of residual stenosis of the infarct-related artery, were found by Ellis and colleagues to derive no benefit from angioplasty [250].Fig. 4


Myocardial perfusion scintigraphy: the evidence.

Underwood SR, Anagnostopoulos C, Cerqueira M, Ell PJ, Flint EJ, Harbinson M, Kelion AD, Al-Mohammad A, Prvulovich EM, Shaw LJ, Tweddel AC, British Cardiac SocietyBritish Nuclear Cardiology SocietyBritish Nuclear Medicine SocietyRoyal College of Physicians of LondonRoyal College of Radiologis - Eur. J. Nucl. Med. Mol. Imaging (2004)

Hard event rates over a mean of 15 months after myocardial infarction according to the number of segments with inducible ischaemia by MPS. Patients with more extensive ischaemia are at progressively higher risk (P=0.017). (From reference [248])
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2562441&req=5

Fig4: Hard event rates over a mean of 15 months after myocardial infarction according to the number of segments with inducible ischaemia by MPS. Patients with more extensive ischaemia are at progressively higher risk (P=0.017). (From reference [248])
Mentions: Travin and colleagues used MPS in 134 patients within 14 days of uncomplicated infarction and showed that the extent of ischaemia was the only significant predictor of future cardiac events on Cox regression analysis (Fig. 4) [248]. Similarly, Basu and colleagues in the UK showed a hazard ratio of 8.1 (95% CI 2.7–23.8, P<0.001) for coronary events comparing patients with and without inducible perfusion abnormalities [249]. Patients with no evidence of inducible ischaemia within the infarct zone, even in the presence of residual stenosis of the infarct-related artery, were found by Ellis and colleagues to derive no benefit from angioplasty [250].Fig. 4

Bottom Line: This in turn allows more appropriate utilisation of resources, with the potential for both improved clinical outcomes and greater cost-effectiveness.Evidence from modelling and observational studies supports the enhanced cost-effectiveness associated with MPS use.In patients presenting with stable or acute chest pain, strategies of investigation involving MPS are more cost-effective than those not using the technique.

View Article: PubMed Central - PubMed

Affiliation: Imperial College London, Royal Brompton Hospital, London, UK. r.underwood@imperial.ac.uk

ABSTRACT
This review summarises the evidence for the role of myocardial perfusion scintigraphy (MPS) in patients with known or suspected coronary artery disease. It is the product of a consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society and is endorsed by the Royal College of Physicians of London and the Royal College of Radiologists. It was used to inform the UK National Institute of Clinical Excellence in their appraisal of MPS in patients with chest pain and myocardial infarction. MPS is a well-established, non-invasive imaging technique with a large body of evidence to support its effectiveness in the diagnosis and management of angina and myocardial infarction. It is more accurate than the exercise ECG in detecting myocardial ischaemia and it is the single most powerful technique for predicting future coronary events. The high diagnostic accuracy of MPS allows reliable risk stratification and guides the selection of patients for further interventions, such as revascularisation. This in turn allows more appropriate utilisation of resources, with the potential for both improved clinical outcomes and greater cost-effectiveness. Evidence from modelling and observational studies supports the enhanced cost-effectiveness associated with MPS use. In patients presenting with stable or acute chest pain, strategies of investigation involving MPS are more cost-effective than those not using the technique. MPS also has particular advantages over alternative techniques in the management of a number of patient subgroups, including women, the elderly and those with diabetes, and its use will have a favourable impact on cost-effectiveness in these groups. MPS is already an integral part of many clinical guidelines for the investigation and management of angina and myocardial infarction. However, the technique is underutilised in the UK, as judged by the inappropriately long waiting times and by comparison with the numbers of revascularisations and coronary angiograms performed. Furthermore, MPS activity levels in this country fall far short of those in comparable European countries, with about half as many scans being undertaken per year. Currently, the number of MPS studies performed annually in the UK is 1,200/million population/year. We estimate the real need to be 4,000/million/year. The current average waiting time is 20 weeks and we recommend that clinically appropriate upper limits of waiting time are 6 weeks for routine studies and 1 week for urgent studies.

Show MeSH
Related in: MedlinePlus