Clinical Evaluation of the Appropriateness Use Criteria for Single-Photon Emission-Computed Tomography: Differences by Patient Population, Physician Specialty, and Patient Outcomes
Table 2
SPECT MPI indications observed in the study: comparison of 2005 and 2009 AUC.
Indications
2005
2009
Detection of CAD:
(i) symptomatic, intermediate or high pretest probability,
A
A
(ii) asymptomatic, moderate Framingham Risk Score (FRS)*,
U
ECG interpret: I, not: U
(iii) asymptomatic, high FRS,
A
A
(iv) asymptomatic, low FRS or symptomatic, ECG interpretable and able to exercise,
I
I
After revascularization (PCI or CABG):
(i) symptomatic,
A
A
(ii) asymptomatic or symptomatic prior to CABG, ≥5 yrs after†,
A
A
(iii) asymptomatic or symptomatic prior to PCI, ≥2 yrs after.
U
U
Prior test results:
(i) asymptomatic or stable symptoms, abnormal catheterization or prior SPECT ≥2 yrs to evaluate worsening disease
A
U
Preoperative evaluation prior to intermediate-high risk noncardiac surgery:
(i) clinical risk factors and poor exercise tolerance (<4 METs),
A
A
(ii) no or minor risk factors, normal exercise tolerance (≥4 METs).
I
I
Unclassified indications:
(i) syncope,
—
Low risk: I, int-high: A
(ii) intermediate Duke treadmill score, low FRS,
—
—
(iii) new onset atrial fibrillation, moderate FRS,
—
U
(iv) asymptomatic, prior myocardial infarct of unknown age,
—
U
(v) symptoms unknown before yrs ago,
—
—
(vi) known CAD; failed PCI,
—
U
(vii) normal SPECT MPI >2 yrs ago, moderate FRS.
—
U
ATP III in 2009 AUC. No symptoms prior to revascularization in 2009 AUC.
