Document Detail


The positive predictive value of myocardial perfusion imaging in screening patients for suspected coronary artery disease.
MedLine Citation:
PMID:  17392995     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In patients with known or suspected coronary artery disease, diagnosis and risk stratification can be aided by non-invasive tests for myocardial ischaemia. The main indications for the use of radionuclide perfusion imaging (sestamibi) rather than exercise electrocardiography include complete left bundle branch block, inconclusive stress electrocardiography and an inability to exercise. The published data on myocardial perfusion imaging is limited to eight studies of only 628 patients with widely varying ranges of sensitivities and specificities and the major problem being the bias created when patients with positive test results are referred far more frequently for coronary angiography than those with negative results. Furthermore, certain categories of patients are postulated to have a high number of false positives, especially obese patients and women, but this hypothesis has not been tested. METHODS AND RESULTS: A retrospective descriptional study on patients with positive sestamibi scans, who had coronary angiography within six months of each other, was performed. The study population consisted of 132 patients, 53.8% of whom were male and 44.7% had a body mass index of less than 28. The overall positive predictive value of the sestamibi scan in predicting significant coronary angiographic stenosis was 63.6%. This value increased significantly to 80.3% in males (p = 0.000). The positive predictive value did not differ in the different age categories, nor did it change with the different indications for sestamibi scanning. CONCLUSIONS: The sestamibi scan remains a useful screening test for coronary artery disease in patients who are exercise intolerant or those with inconclusive stress electrocardiography. The test is highly predictive in males rather than females.
Authors:
S Ellemdin; P Soma
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular journal of South Africa : official journal for Southern Africa Cardiac Society [and] South African Society of Cardiac Practitioners     Volume:  18     ISSN:  1015-9657     ISO Abbreviation:  Cardiovasc J S Afr     Publication Date:    2007 Jan-Feb
Date Detail:
Created Date:  2007-03-29     Completed Date:  2007-09-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100964061     Medline TA:  Cardiovasc J S Afr     Country:  South Africa    
Other Details:
Languages:  eng     Pagination:  36-8     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, University of Pretoria, Pretoria.
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Angiography
Coronary Artery Disease / diagnosis*,  epidemiology,  physiopathology
Coronary Stenosis / diagnosis,  epidemiology,  physiopathology
Exercise Test
Exercise Tolerance
Female
Follow-Up Studies
Humans
Male
Mass Screening*
Middle Aged
Myocardial Reperfusion*
Observer Variation
Predictive Value of Tests
Radiopharmaceuticals / diagnostic use
Research Design
Retrospective Studies
Stroke Volume
Technetium Tc 99m Sestamibi / diagnostic use
Tomography, Emission-Computed, Single-Photon / methods
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi

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