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Differential Impact of Appropriate Use Criteria on the Association between Age and an Abnormal Stress Myocardial

Saurabh Malhotra1,2, Rami Doukky1,2

  • 1Division of Cardiology, Cook County Health, Chicago, IL.

Cardiovascular Innovations and Applications
|May 10, 2019
PubMed

Insights

Appropriate Use Criteria (AUC) for coronary artery disease (CAD) testing did not predict abnormal SPECT MPI results in elderly patients. Caution is advised when using AUC for referring older adults for this cardiac imaging.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Geriatrics

Background:

  • Appropriate Use Criteria (AUC) are established for diagnosing coronary artery disease (CAD).
  • The diagnostic yield of AUC in elderly populations for CAD prediction remains unclear.
  • SPECT myocardial perfusion imaging (MPI) is a key diagnostic tool.

Purpose of the Study:

  • To evaluate if AUC for SPECT MPI preserves its diagnostic yield in predicting CAD among elderly patients.
  • To assess the relationship between AUC and abnormal SPECT MPI findings in different age groups.

Main Methods:

  • A prospective cohort of 1511 patients undergoing outpatient SPECT MPI was analyzed.
  • Study appropriateness was determined using 2013 multimodality AUC for ischemic heart disease.
  • Abnormal SPECT MPI was defined by specific summed stress and difference scores.

Main Results:

  • Age ≥ 60 years, male gender, hypertension, diabetes, and known CAD predicted abnormal SPECT MPI.
  • Appropriate indication for testing did not predict abnormal SPECT MPI in the elderly.
  • Among elderly patients, appropriateness of testing did not influence the prevalence of abnormal SPECT MPI or ischemia.

Conclusions:

  • AUC did not discriminate the risk of abnormal SPECT MPI in the elderly cohort.
  • Relying solely on AUC for referring elderly patients for SPECT MPI requires caution.
  • Further research may be needed to refine AUC for geriatric cardiac diagnostics.
Abstract

Keywords:
SPECTageappropriate use criteriacoronary artery diseasemyocardial perfusion imaging

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