Appropriate Use Criteria Improve Prognostic Value of SPECT Myocardial Perfusion Studies

Background: Myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT) is one of the most thoroughly evaluated diagnostic imaging studies, with well-established prognostic value for the prediction of major adverse cardiac events (MACE) and incremental value to clinical and angiographic data. The ASNC, AHA, ACR, and other organizations have devised appropriate use criteria (AUC), which generally call for SPECT MPI when the patient's pretest risk is intermediate or when the probability of having coronary artery disease is high but patient management is likely to be influenced by the scan results. Objective: To test the hypothesis that inappropriate use diminishes the prognostic value of SPECT MPI. Design: Prospective cohort study. Participants: Consecutive patients referred for SPECT MPI to 11 community practices in the Chicago metropolitan area. Methods: Patients underwent imaging at the discretion of their physicians. Appropriateness was determined lat more...