Document Detail


Value of stress myocardial perfusion single photon emission computed tomography in patients with normal resting electrocardiograms: an evaluation of incremental prognostic value and cost-effectiveness.
MedLine Citation:
PMID:  11854122     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The incremental value and cost-effectiveness of stress single photon emission computed tomography (SPECT) is of unclear added value over clinical and exercise treadmill testing data in patients with normal resting ECGs, a patient subset known to be at relatively lower risk. METHODS AND RESULTS: We identified 3058 consecutive patients who underwent exercise dual isotope SPECT, who on follow-up (mean, 1.6+/-0.5 years; 3.6% lost to follow-up) were found to have 70 hard events (2.3% hard-event rate). Survival analysis used a Cox proportional hazards model, and cost-effectiveness was determined by the cost per hard event identified by strategies with versus without the use of SPECT. In this cohort, a normal study was associated with an exceedingly low hard-event rate (0.4% per year) that increased significantly as a function of the SPECT result. After adjusting for pre-SPECT information, exercise stress SPECT yielded incremental value for the prediction of hard events (chi2 52 to 85, P<0.001) and significantly stratified patients. In patients with intermediate to high likelihood of coronary artery disease after exercise treadmill testing, a cost-effectiveness ratio of $25 134 per hard event identified and a cost of $5417 per reclassification of patient risk were found. Subset analyses revealed similar prognostic, and cost results were present in men, women, and patients with and without prior histories of coronary artery disease. CONCLUSIONS: Stress SPECT yields incremental prognostic value and enhanced risk stratification in patients with normal resting ECGs in a cost-effective manner. These findings are opposite those of previous studies examining anatomic end points in this same population and thus, if confirmed, have significant implications for patient management.
Authors:
Rory Hachamovitch; Daniel S Berman; Hosen Kiat; Ishac Cohen; John D Friedman; Leslee J Shaw
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  105     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2002 Feb 
Date Detail:
Created Date:  2002-02-20     Completed Date:  2002-02-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  823-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Imaging (Division of Nuclear Medicine), Cedars-Sinai Medical Center, University of California Los Angeles School of Medicine, Los Angeles, Calif 90048, USA.
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MeSH Terms
Descriptor/Qualifier:
Cohort Studies
Coronary Artery Disease / diagnosis*,  economics*,  physiopathology
Coronary Circulation
Coronary Vessels / physiopathology,  radionuclide imaging
Cost-Benefit Analysis / statistics & numerical data*
Disease-Free Survival
Electrocardiography*
Exercise Test
Female
Follow-Up Studies
Humans
Male
Middle Aged
Outcome Assessment (Health Care) / economics
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Risk Assessment / economics
Sex Factors
Survival Analysis
Technetium Tc 99m Sestamibi / diagnostic use
Thallium Radioisotopes / diagnostic use
Tomography, Emission-Computed, Single-Photon / economics*
United States
Chemical
Reg. No./Substance:
0/Thallium Radioisotopes; 109581-73-9/Technetium Tc 99m Sestamibi
Comments/Corrections
Comment In:
Circulation. 2002 Oct 8;106(15):e71-2; author reply e71-2   [PMID:  12370237 ]

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


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