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Impact of Myocardial Perfusion Imaging with PET and ⁸²Rb on Downstream Invasive Procedure Utilization, Costs, and Outcomes in Coronary Disease Management

Michael E. Merhige^1,2, William J. Breen^,1,3, Victoria Shelton², Teresa Houston³, Brian J. D'Arcy^1,3 and Anthony F. Perna¹

¹ Departments of Cardiology, Internal Medicine, and Nuclear Medicine, State University of New York at Buffalo, Buffalo, New York; ² Heart Center of Niagara, Niagara Falls, New York; and ³ Buffalo Cardiology and Pulmonary Associates, Buffalo, New York

View larger version (28K): [in this window] [in a new window]   FIGURE 1.  Utilization rates of diagnostic coronary arteriography (Angio), PTCI, and CABG in patients studied with SPECT vs. PET MPI. REVASC = revascularization.

View larger version (18K): [in this window] [in a new window]   FIGURE 2.  Clinical outcomes at average 1-y follow-up in patients studied with SPECT vs. PET MPI. NS = not statistically significant.

View larger version (25K): [in this window] [in a new window]   FIGURE 3.  CAD management costs in patients studied with SPECT vs. PET MPI.

View larger version (58K): [in this window] [in a new window]   FIGURE 4.  Examples of improved diagnostic reliability of PET vs. SPECT MPI in the same patients. (A) A 70-y-old man status post CABG with no history of MI. Exercise/rest SPECT images are normal but left ventricular ejection fraction was surprisingly reduced at 0.39. PET MPI within 2 wk discloses a clinically occult posterobasal MI. (B) A 53-y-old man with exertional left arm pain. SPECT images with dipyridamole stress are normal. PET MPI within 2 wk demonstrates a reversible inferoseptal perfusion defect. Ninety percent circumflex stenosis found on coronary arteriography. (C) A 46-y-old woman with chest pain. SPECT images are equivocal for reversible ischemia in inferolateral wall. PET images are normal. (D) A 59-y-old woman with chest pain. SPECT images are equivocal for reversible inferolateral ischemia as in C. PET images demonstrate reversible inferoseptal perfusion defect, treated with PTCI of 95% dominant right coronary artery stenosis.