[Optimizing resources in nuclear cardiology].

Abstract

Myocardial perfusion SPECT imaging (MPI) provides substantial diagnostic and prognostic information in patients with known or suspected coronary artery disease (CAD). Furthermore, it has been demonstrated that the application of MPI results is a cost-effective modification of patient management. Several studies have demonstrated that a chest pain center (CPC) using MPI significantly reduce the number of patients hospitalized from the emergency department for further evaluation of chest pain, and restricted hospitalization to more appropriate patients. However, time-consuming and costs of MPI studies might represent a significant issue for patients and nuclear laboratory logistics. We addressed the question whether in patients evaluated for CAD stress with only MPI might reduce costs and time without loosing the efficacy for detecting CAD. We included a consecutive series of 122 patients. All patients underwent stress-only Tc99m sestamibi MPI. The study population was divided into two groups: group I consisted of 26 patients with stress-only abnormal MPI and group 2 consisted of 96 patients with stress-only normal MPI. All group I patients underwent angiography and showed a significant lesion in at least one vessel in 22 patients. Mean follow-up of group II patients was 12.65 +/- 2.83 months and the overall cardiac event rate was 0.2%. Stress-only MPI was completed in a shorter period of time than reststress MPI (57 +/- 5.95 vs 180 +/- 2 minutes, p < 0.000.1). In addition, stress-only MPI studies saved 40% of costs. We concluded that in patients with low to medium pretest probability for CAD, stress-only MPI results in a safety strategy that improves cost-efficiency and decreases demand on nuclear laboratory time.