Research ArticleCLINICAL INVESTIGATIONS

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

Michael E. Merhige, William J. Breen, Victoria Shelton, Teresa Houston, Brian J. D'Arcy and Anthony F. Perna
Journal of Nuclear Medicine July 2007, 48 (7) 1069-1076; DOI: https://doi.org/10.2967/jnumed.106.038323

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    Utilization rates of diagnostic coronary arteriography (Angio), PTCI, and CABG in patients studied with SPECT vs. PET MPI. REVASC = revascularization.

  • FIGURE 2. 
    FIGURE 2. 

    Clinical outcomes at average 1-y follow-up in patients studied with SPECT vs. PET MPI. NS = not statistically significant.

  • FIGURE 3. 
    FIGURE 3. 

    CAD management costs in patients studied with SPECT vs. PET MPI.

  • FIGURE 4. 
    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.

Tables

  • TABLE 1

    Diagnostic Algorithm Used to Identify Patients Suitable for Direct PET MPI on the Basis of Their Pretest Likelihood of CAD or Ischemia (pCAD)

    pCADDiagnostic test
    0–10Reassurance or treadmill electrocardiography
    11–70Stress PET MPI
    71–89Stress SPECT MPI
    90–100Direct coronary angiography

    • Only patients with moderate pCAD (0.11–0.70) were routed to PET MPI as initially suggested by the econometric model of Patterson et al. (8). Patients with pCAD < 0.11 or > 0.70 were excluded from the study.

  • TABLE 2

    Estimated Global Charges for CAD Diagnostic Tests

    TestGlobal charge ($)
    Exercise treadmill ECG300
    SPECT with exercise treadmill ECG1,000
    PET with pharmacologic stress1,850
    Coronary angiography4,800
    PTCI10,000
    CABG40,000

    • ECG = electrocardiography.

  • TABLE 3

    Patient Demographics and pCAD in Subgroups in the Internal SPECT Control Group and PET Group with Known [(+) CAD] vs. Suspected [(?) CAD] CAD Status Before Testing

    Patient demographicsSPECT*PET*
    Patients (n)1022,159
    Median age (y)62 ± 1166 ± 8
    Male (n)55 (54)1,166 (54)
    Female (n)47 (46)993 (46)
    Known (+)CAD (n)45 (44)1,058 (49)
    pCAD: + CAD0.461 ± 0.050.474 ± 0.15
    Possible (?) CAD (n)57 (56)1,101 (51)
    pCAD: ?CAD0.291 ± 0.140.333 ± 0.10

    • ↵* Values in parentheses are percentages.

    • SPECT vs. PET groups are well matched for sex and proportion of patients with known CAD.

  • TABLE 4

    Indications for Study with SPECT or PET MPI

    Indication%
    Chest pain53
    Dyspnea on exertion18
    Abnormal SPECT/ECHO9
    S/P coronary revascularization7
    Resolution of equivocal SPECT7
    Other6

    • S/P = status post; ECHO= echocardiography.

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