| Impact of myocardial perfusion imaging with PET and (82)Rb on downstream invasive procedure utilization, costs, and outcomes in coronary disease management. | |
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MedLine Citation:
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PMID: 17607038 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Michael E Merhige; William J Breen; Victoria Shelton; Teresa Houston; Brian J D'Arcy; Anthony F Perna |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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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:
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Created Date: 2007-07-03 Completed Date: 2007-08-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0217410 Medline TA: J Nucl Med Country: United States |
Other Details:
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Languages: eng Pagination: 1069-76 Citation Subset: IM |
Affiliation:
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Departments of Cardiology, Internal Medicine, and Nuclear Medicine, State University of New York at Buffalo, Buffalo, New York 14302, USA. merhige@buffalo.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Radiopharmaceuticals; 0/Rubidium Radioisotopes |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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