Author + information
- Kaelin DeMuth,
- Joseph Freedman,
- Marlow Hernandez,
- Jaime Rodriguez,
- Randall Schwartz,
- Irene Lambiris,
- Craig Asher,
- Gian Novaro,
- David Wolinsky,
- Martin Harris,
- Randall Starling and
- Michael Shen
SPECT Appropriateness Criteria (AC) has been established for quality of care since 2005. Our prior study showed AC predictive powers (AHA 2011:239), but no data on long-term follow-up in pts with appropriate (A) or inappropriate (I). This study sought to evaluate AC effectiveness using major adverse cardiac events (MACE) in 1-year follow-up.
All pts with SPECT during 1-year were included. Out-pt visits were retrospectively evaluated prior to SPECT referral using 2009 AC to determine A, I, or uncertain (U). MACE was followed for 1-year.
Of 65,922 consecutive pts, 924 had SPECT. No significant MACE (n=59, 6.4%) between A and I (HR 1.23, p=0.47) over 1 year. Predictive A's were: A30-New/worsening symptoms with abnormal prior imaging (26%, OR 5.65, p <0.001), and A55-Symptomatic pts post PCI or CABG (10%, OR 1.89, p=0.06). However, A43-Preop with ≥ 1 risk factor and <4 METS had a low MACE (3%, OR 0.4, p=0.3). Furthermore, relative high MACE was seen in I13-Intermediate CHD risk (15%, OR 2.79, p=0.07), I27-Asymptomatic, known CAD, prior stress test < 2 years (9%, OR 1.39, p=0.59), and I59-Asymptomatic pts < 2 years after PCI/CABG (11%, OR 1.89, p=0.24). Based on the MACE, 4 ACs were reclassified: A43 to I; I13, I27, and I59 to U. Reclassification resulted in significant delineation of MACE in A and I (HR 1.94, p <0.05).
Reclassifying some ACs may increase effectiveness of outcome predications. Further research on AC is warranted on clinical outcomes before AC is widely applied to clinical settings.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: SPECT: Appropriate Use Criteria and Role in Specific Populations
Abstract Category: 21. Imaging: Nuclear
Presentation Number: 1229-360
- 2013 American College of Cardiology Foundation