Systematic review of the prognostic effectiveness of SPECT myocardial perfusion scintigraphy in patients with suspected or known coronary artery disease and following myocardial infarction

Graham Mowatt, Miriam Brazelli, Howard Gemmell, Graham S Hillis, Malcom Metcalfe, Luke Vale, Aberdeen Technology Assessment Review (TAR) Group

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objectives In patients with suspected or known coronary artery disease (CAD), or following myocardial infarction (MI), assessing the degree of ischaemia is important from a prognostic and therapeutic point of view. Single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy (MPS) is a non-invasive technique that allows the presence, location and extent of ischaemia to be determined. The aim of this systematic review was to assess the prognostic effectiveness of SPECT MPS.

Methods We sought prognostic studies involving SPECT, exercise tolerance testing (ETT) and/or coronary angiography (CA) in people with suspected or known CAD, or following MI. Outcomes included cardiac death, non-fatal MI and revascularization. We searched the following databases: MEDLINE, PREMEDLINE, EMBASE, BIOSIS, Science Citation Index, the Cochrane Library, the Health Management Information Consortium and the Health Technology Assessment Database.

Results Twenty-one observational studies enrolling 53,762 people reported the general prognostic value of SPECT MPS. In multivariate analysis, SPECT MPS variables yielded both independent and incremental value to combinations of clinical, ETT and angiographic variables in predicting cardiac death or non-fatal MI. Three comparative studies reported lower revascularization rates following a SPECT MPS-CA strategy (6-21%) compared with direct CA (16-44%). Four observational studies enrolling 2106 people reported the prognostic value of SPECT for patients following MI. In multivariate analysis including clinical history, ETT, SPECT MPS and angiographic variables, strategies involving SPECT MPS provided independent and incremental prognostic performance in predicting future cardiac events.

Conclusions SPECT MPS provides important additional information to that from ETT and/or CA that helps to risk-stratify patients with suspected or known CAD or following MI, enabling them to be managed more appropriately. Increasing the use of strategies involving SPECT MPS may identify lower risk patients for whom invasive CA might be avoided. Nucl Med Commun 26:217-229 (c) 2005 Lippincott Williams C Wilkins.

Original languageEnglish
Pages (from-to)217-229
Number of pages13
JournalNuclear Medicine Communications
Volume26
Issue number3
DOIs
Publication statusPublished - Mar 2005

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Myocardial Perfusion Imaging
Perfusion Imaging
Single-Photon Emission-Computed Tomography
Coronary Artery Disease
Myocardial Infarction
Coronary Angiography
Exercise Tolerance
Observational Studies
Multivariate Analysis
Ischemia
Health Information Management
Databases
Biomedical Technology Assessment
Myocardial Revascularization
MEDLINE
Libraries

Keywords

  • coronary artery disease
  • CAD
  • myocardial perfusion scintigraphy
  • myocardial infarction
  • prognostic utility
  • single photon emission computed tomography
  • SPECT
  • emission computed-tomography
  • practice guidelines committee
  • association task-force
  • stable chest-pain
  • risk stratification
  • exercise TL-201
  • cardiac risk
  • prediction
  • impact
  • catheterization

Cite this

Systematic review of the prognostic effectiveness of SPECT myocardial perfusion scintigraphy in patients with suspected or known coronary artery disease and following myocardial infarction. / Mowatt, Graham; Brazelli, Miriam; Gemmell, Howard; Hillis, Graham S; Metcalfe, Malcom; Vale, Luke; Aberdeen Technology Assessment Review (TAR) Group.

In: Nuclear Medicine Communications, Vol. 26, No. 3, 03.2005, p. 217-229.

Research output: Contribution to journalArticle

Mowatt, Graham ; Brazelli, Miriam ; Gemmell, Howard ; Hillis, Graham S ; Metcalfe, Malcom ; Vale, Luke ; Aberdeen Technology Assessment Review (TAR) Group. / Systematic review of the prognostic effectiveness of SPECT myocardial perfusion scintigraphy in patients with suspected or known coronary artery disease and following myocardial infarction. In: Nuclear Medicine Communications. 2005 ; Vol. 26, No. 3. pp. 217-229.
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abstract = "Objectives In patients with suspected or known coronary artery disease (CAD), or following myocardial infarction (MI), assessing the degree of ischaemia is important from a prognostic and therapeutic point of view. Single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy (MPS) is a non-invasive technique that allows the presence, location and extent of ischaemia to be determined. The aim of this systematic review was to assess the prognostic effectiveness of SPECT MPS.Methods We sought prognostic studies involving SPECT, exercise tolerance testing (ETT) and/or coronary angiography (CA) in people with suspected or known CAD, or following MI. Outcomes included cardiac death, non-fatal MI and revascularization. We searched the following databases: MEDLINE, PREMEDLINE, EMBASE, BIOSIS, Science Citation Index, the Cochrane Library, the Health Management Information Consortium and the Health Technology Assessment Database.Results Twenty-one observational studies enrolling 53,762 people reported the general prognostic value of SPECT MPS. In multivariate analysis, SPECT MPS variables yielded both independent and incremental value to combinations of clinical, ETT and angiographic variables in predicting cardiac death or non-fatal MI. Three comparative studies reported lower revascularization rates following a SPECT MPS-CA strategy (6-21{\%}) compared with direct CA (16-44{\%}). Four observational studies enrolling 2106 people reported the prognostic value of SPECT for patients following MI. In multivariate analysis including clinical history, ETT, SPECT MPS and angiographic variables, strategies involving SPECT MPS provided independent and incremental prognostic performance in predicting future cardiac events.Conclusions SPECT MPS provides important additional information to that from ETT and/or CA that helps to risk-stratify patients with suspected or known CAD or following MI, enabling them to be managed more appropriately. Increasing the use of strategies involving SPECT MPS may identify lower risk patients for whom invasive CA might be avoided. Nucl Med Commun 26:217-229 (c) 2005 Lippincott Williams C Wilkins.",
keywords = "coronary artery disease, CAD, myocardial perfusion scintigraphy, myocardial infarction, prognostic utility, single photon emission computed tomography, SPECT, emission computed-tomography, practice guidelines committee, association task-force, stable chest-pain, risk stratification, exercise TL-201, cardiac risk, prediction, impact, catheterization",
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T1 - Systematic review of the prognostic effectiveness of SPECT myocardial perfusion scintigraphy in patients with suspected or known coronary artery disease and following myocardial infarction

AU - Mowatt, Graham

AU - Brazelli, Miriam

AU - Gemmell, Howard

AU - Hillis, Graham S

AU - Metcalfe, Malcom

AU - Vale, Luke

AU - Aberdeen Technology Assessment Review (TAR) Group

PY - 2005/3

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N2 - Objectives In patients with suspected or known coronary artery disease (CAD), or following myocardial infarction (MI), assessing the degree of ischaemia is important from a prognostic and therapeutic point of view. Single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy (MPS) is a non-invasive technique that allows the presence, location and extent of ischaemia to be determined. The aim of this systematic review was to assess the prognostic effectiveness of SPECT MPS.Methods We sought prognostic studies involving SPECT, exercise tolerance testing (ETT) and/or coronary angiography (CA) in people with suspected or known CAD, or following MI. Outcomes included cardiac death, non-fatal MI and revascularization. We searched the following databases: MEDLINE, PREMEDLINE, EMBASE, BIOSIS, Science Citation Index, the Cochrane Library, the Health Management Information Consortium and the Health Technology Assessment Database.Results Twenty-one observational studies enrolling 53,762 people reported the general prognostic value of SPECT MPS. In multivariate analysis, SPECT MPS variables yielded both independent and incremental value to combinations of clinical, ETT and angiographic variables in predicting cardiac death or non-fatal MI. Three comparative studies reported lower revascularization rates following a SPECT MPS-CA strategy (6-21%) compared with direct CA (16-44%). Four observational studies enrolling 2106 people reported the prognostic value of SPECT for patients following MI. In multivariate analysis including clinical history, ETT, SPECT MPS and angiographic variables, strategies involving SPECT MPS provided independent and incremental prognostic performance in predicting future cardiac events.Conclusions SPECT MPS provides important additional information to that from ETT and/or CA that helps to risk-stratify patients with suspected or known CAD or following MI, enabling them to be managed more appropriately. Increasing the use of strategies involving SPECT MPS may identify lower risk patients for whom invasive CA might be avoided. Nucl Med Commun 26:217-229 (c) 2005 Lippincott Williams C Wilkins.

AB - Objectives In patients with suspected or known coronary artery disease (CAD), or following myocardial infarction (MI), assessing the degree of ischaemia is important from a prognostic and therapeutic point of view. Single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy (MPS) is a non-invasive technique that allows the presence, location and extent of ischaemia to be determined. The aim of this systematic review was to assess the prognostic effectiveness of SPECT MPS.Methods We sought prognostic studies involving SPECT, exercise tolerance testing (ETT) and/or coronary angiography (CA) in people with suspected or known CAD, or following MI. Outcomes included cardiac death, non-fatal MI and revascularization. We searched the following databases: MEDLINE, PREMEDLINE, EMBASE, BIOSIS, Science Citation Index, the Cochrane Library, the Health Management Information Consortium and the Health Technology Assessment Database.Results Twenty-one observational studies enrolling 53,762 people reported the general prognostic value of SPECT MPS. In multivariate analysis, SPECT MPS variables yielded both independent and incremental value to combinations of clinical, ETT and angiographic variables in predicting cardiac death or non-fatal MI. Three comparative studies reported lower revascularization rates following a SPECT MPS-CA strategy (6-21%) compared with direct CA (16-44%). Four observational studies enrolling 2106 people reported the prognostic value of SPECT for patients following MI. In multivariate analysis including clinical history, ETT, SPECT MPS and angiographic variables, strategies involving SPECT MPS provided independent and incremental prognostic performance in predicting future cardiac events.Conclusions SPECT MPS provides important additional information to that from ETT and/or CA that helps to risk-stratify patients with suspected or known CAD or following MI, enabling them to be managed more appropriately. Increasing the use of strategies involving SPECT MPS may identify lower risk patients for whom invasive CA might be avoided. Nucl Med Commun 26:217-229 (c) 2005 Lippincott Williams C Wilkins.

KW - coronary artery disease

KW - CAD

KW - myocardial perfusion scintigraphy

KW - myocardial infarction

KW - prognostic utility

KW - single photon emission computed tomography

KW - SPECT

KW - emission computed-tomography

KW - practice guidelines committee

KW - association task-force

KW - stable chest-pain

KW - risk stratification

KW - exercise TL-201

KW - cardiac risk

KW - prediction

KW - impact

KW - catheterization

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M3 - Article

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JO - Nuclear Medicine Communications

JF - Nuclear Medicine Communications

SN - 0143-3636

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