Document Detail


Impact of myocardial perfusion imaging with PET and (82)Rb on downstream invasive procedure utilization, costs, and outcomes in coronary disease management.
MedLine Citation:
PMID:  17607038     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We hypothesized that PET myocardial perfusion imaging with (82)Rb (PET MPI), would reduce downstream utilization of diagnostic arteriography, compared with SPECT, in patients matched for pretest likelihood of coronary disease (pCAD). PET MPI is more accurate for assessment of impaired coronary flow reserve compared with SPECT MPI, potentially reducing the demand for subsequent arteriography, percutaneous trans-coronary intervention, and coronary artery bypass grafting (CABG), with attendant cost savings, while avoiding a negative impact on coronary events. METHODS: The frequency of diagnostic arteriography, revascularization, costs, and 1-y clinical outcomes in 2,159 patients studied with PET MPI was compared with 2 control groups studied with SPECT MPI matched to the PET group by pCAD: an internal control group of 102 patients and an external SPECT control group of 5,826 patients. CAD management costs were approximated with realistic global fee estimates. RESULTS: Arteriography rates were 0.34 and 0.31 for the external and internal control SPECT groups and 0.13 for the patients studied with PET (P < 0.0001). pCAD averaged 0.39 in patients studied with PET MPI, and in the external SPECT control group, and 0.37 in the internal SPECT controls. Revascularization rates were 0.13 and 0.11 for external and internal SPECT patients and 0.06 for the PET group (P < 0.0001; P < 0.01), with a cost savings of 30% noted for PET patients, with no significant difference in cardiac death or myocardial infarction at 1-y follow-up. CONCLUSION: PET MPI in patients with intermediate pCAD results in a >50% reduction in invasive coronary arteriography and CABG, a 30% cost savings, and excellent clinical outcomes at 1 y compared with SPECT.
Authors:
Michael E Merhige; William J Breen; Victoria Shelton; Teresa Houston; Brian J D'Arcy; Anthony F Perna
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of nuclear medicine : official publication, Society of Nuclear Medicine     Volume:  48     ISSN:  0161-5505     ISO Abbreviation:  J. Nucl. Med.     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-07-03     Completed Date:  2007-08-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0217410     Medline TA:  J Nucl Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1069-76     Citation Subset:  IM    
Affiliation:
Departments of Cardiology, Internal Medicine, and Nuclear Medicine, State University of New York at Buffalo, Buffalo, New York 14302, USA. merhige@buffalo.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary / utilization
Coronary Angiography / utilization
Coronary Artery Bypass / utilization
Coronary Circulation*
Coronary Disease / economics*,  radionuclide imaging*,  surgery
Cost Savings
Female
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis
Positron-Emission Tomography / methods
Radiopharmaceuticals / diagnostic use
Rubidium Radioisotopes / diagnostic use*
Tomography, Emission-Computed, Single-Photon / methods
Treatment Outcome
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 0/Rubidium Radioisotopes

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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