Pretest models for predicting abnormal stress single-photon emission computed tomography myocardial perfusion imaging.
Aged
Coronary Artery Disease
/ diagnostic imaging
Exercise Test
Female
Heart Disease Risk Factors
Humans
Male
Middle Aged
Models, Cardiovascular
Myocardial Perfusion Imaging
Patient Selection
Predictive Value of Tests
ROC Curve
Retrospective Studies
Risk Assessment
Tomography, Emission-Computed, Single-Photon
CAD
MPI
SPECT
diagnostic and prognostic application
Journal
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
ISSN: 1532-6551
Titre abrégé: J Nucl Cardiol
Pays: United States
ID NLM: 9423534
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
02
08
2019
accepted:
17
10
2019
pubmed:
12
12
2019
medline:
22
3
2022
entrez:
12
12
2019
Statut:
ppublish
Résumé
The frequency of abnormal stress SPECT myocardial perfusion imaging (MPS) decreased over the past decades despite an increase in the prevalence of cardiovascular risk factors. These findings strengthen the need to develop more effective strategies for appropriately referring patients with suspected coronary artery disease (CAD) to cardiac imaging. The aim of this study was to develop pretest assessment models for predicting abnormal stress MPS. We included 5,601 consecutive patients with suspected CAD, who underwent stress MPS at our academic center. Two different models were considered: a basic model including age, gender, and anginal symptoms; and a clinical model including also diabetes, hypertension, hypercholesterolemia, smoking, and family history of CAD. In patients with abnormal MPS, the basic model classified more than 75% of patients as intermediate risk, whereas only 23% were incorrectly classified as low risk. In patients with normal MPS, 45% were correctly classified as low risk and none as high risk. Basic and clinical models had a limited discriminating capacity (area under the receiver operating characteristic curve 0.644 for basic model and 0.647 for clinical model) between individuals with and without abnormal stress MPS. The decision curve analysis demonstrates a high net benefit across a range of threshold probabilities from ~ 15% to ~30% for both models. A pretest risk stratification based on traditional cardiovascular risk factors has a limited value for predicting an abnormal stress MPS in patients with suspected CAD. However, selecting a proper threshold probability enhances the appropriateness of referral to stress MPS.
Sections du résumé
BACKGROUND
The frequency of abnormal stress SPECT myocardial perfusion imaging (MPS) decreased over the past decades despite an increase in the prevalence of cardiovascular risk factors. These findings strengthen the need to develop more effective strategies for appropriately referring patients with suspected coronary artery disease (CAD) to cardiac imaging. The aim of this study was to develop pretest assessment models for predicting abnormal stress MPS.
METHODS
We included 5,601 consecutive patients with suspected CAD, who underwent stress MPS at our academic center. Two different models were considered: a basic model including age, gender, and anginal symptoms; and a clinical model including also diabetes, hypertension, hypercholesterolemia, smoking, and family history of CAD.
RESULTS
In patients with abnormal MPS, the basic model classified more than 75% of patients as intermediate risk, whereas only 23% were incorrectly classified as low risk. In patients with normal MPS, 45% were correctly classified as low risk and none as high risk. Basic and clinical models had a limited discriminating capacity (area under the receiver operating characteristic curve 0.644 for basic model and 0.647 for clinical model) between individuals with and without abnormal stress MPS. The decision curve analysis demonstrates a high net benefit across a range of threshold probabilities from ~ 15% to ~30% for both models.
CONCLUSIONS
A pretest risk stratification based on traditional cardiovascular risk factors has a limited value for predicting an abnormal stress MPS in patients with suspected CAD. However, selecting a proper threshold probability enhances the appropriateness of referral to stress MPS.
Identifiants
pubmed: 31823327
doi: 10.1007/s12350-019-01941-3
pii: 10.1007/s12350-019-01941-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1891-1902Informations de copyright
© 2019. American Society of Nuclear Cardiology.
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