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2003, Number s1

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Arch Cardiol Mex 2003; 73 (s1)

Cost effectiveness in nuclear cardiology

Vallejo VE
Full text How to cite this article

Language: Spanish
References: 8
Page: 150-152
PDF size: 45.09 Kb.


Key words:

Myocardial perfusion, SPECT imaging (MPI), Stress-only.

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 Tc-99m 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 rest-stress 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.


REFERENCES

  1. Bar Harbor meeting 2000, American Society of Nuclear Cardiology. J Nucl Cardiol 2001; 8: 224-316.

  2. Shaw LJ, Hachamovitch R, Berman DS, Marwick TH, Lauer MS, et al: The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. J Am Coll Cardiol 1999; 33: 661-669.

  3. Hachamovitch R: Cost effectiveness in nuclear cardiology. Presented at 4th International Conference of Nuclear Cardiology. Atenas, Grecia 1999. www.asnc.org

  4. Abott BG, Abdel-Aziz I, Nagula S, Monico EP, Schriver JA, et al: Selective use of single-photon emission computed tomography myoacardial perfusion imaging in a chest pain center. Am J Cardiol 2001; 87: 1351-55.

  5. Varetto T, Cantalupi D, Altieri A, Orlandi C: Emergency room technetium-99m sestamibi imaging to rule out acute myocardial ischemic events in patients quth nondiagnostic electrocardiograms. J Am Coll Cardiol 1993; 22: 1804-8.

  6. Stowers SA, Eisenstein EL, Wackers F, Berman DS, Blackshear JL, Jones AD Jr, et al: An economic analysis of an aggressive diagnostic strategy with single photon emission computed tomography myocardial perfusion imaging and early exercise stress testing in emergency department patients who present with chest pain but nondiagnostic electrocardiogram, results from a randomized trial. Ann Emerg Med 2000; 35: 17-25.

  7. Udelson JE: The ERASE Chest Pain Trial. Presented at “Special Session: Clinical Trials” at the 72nd Scientific Sessions of the American Heart Association, Atlanta, Ga, November 10, 1999.

  8. Acevedo C, Vallejo E: Optimización de los recursos en cardiología nuclear para el diagnóstico de cardiopatía isquémica. Selección del protocolo de imagen con base en la estratificación del riesgo clínico. Tesis para obtener el grado de especialista en cardiología nuclear. Instituto Nacional de Cardiología “Ignacio Chávez”, Universidad Nacional Autónoma de México, 2002.




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Arch Cardiol Mex. 2003;73