1. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
TRIAGE OF PATIENTS FOR ATTENUATION CORRECTED STRESS-FIRST TC-99M SPECT MPI USING A SIMPLIFIED CLINICAL PRE-TEST SCORING MODEL
Shreyas Gowdar, MD,* Waseem Chaudhry, MD,† Alan W. Ahlberg, MA,* Milena J. Henzlova, MD,‡ W. Lane Duvall, MD*
*Division of Cardiology (Hartford Hospital), Hartford, CT
†Division of Cardiology, Maine Medical Center, Portland, ME
‡Mount Sinai Division of Cardiology (Mount Sinai Heart), New York, NY
Copyright American Society of Nuclear Cardiology

2. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
BACKGROUND
1- Stress-only Tc-99m SPECT MPI saves time and reduces radiation exposure with a benign prognosis of normal studies.
2- No guidelines exist as to which patients should undergo stress-first MPI.
3- The purpose of this study was to validate a previously published pre-test prediction scoring model and refine/simplify the stress-first triage process further by triaging based on CAD status alone.
Copyright American Society of Nuclear Cardiology

3. METHODS Study type: Study subjects: Study endpoints: Study variables
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
METHODS
Study type:
Retrospective cohort study.
Study subjects:
All patients who underwent an attenuation corrected Tc-99m SPECT MPI over a 39-month period.
Study endpoints:
Primary end point(s): the previously published prediction score was compared to triage based on CAD status alone in predicting a successful stress-first study.
Study variables
Age, gender, diabetes, typical chest pain, congestive heart failure, abnormal resting ECG, documented CAD, ED location, myocardial perfusion results.
Copyright American Society of Nuclear Cardiology

4. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Accuracy of predicting successful stress-first MPI (SAS ≤ 1) by use of prediction score, CAD status, and CAD status combined with history of CHF or abnormal ECG.
Copyright American Society of Nuclear Cardiology

5. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Comparison of stepwise logistic regression model derived global Chi square values for various triage strategies.
Copyright American Society of Nuclear Cardiology

6. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
CONCLUSIONS
1- The previously described prediction score effectively identifies patients who can successfully undergo stress-first MPI with attenuation correction but it is cumbersome.
2- Triaging based solely on CAD status is practical and provides improved predictive accuracy for successful stress-first MPI.
3- Other key variables (CHF and abnormal resting ECG) can be added to the triage process if desired.
4- Utilizing this simplified pre-test scoring model may allow for wider adoption of stress-first imaging protocols which have clear advantages over traditional rest-stress protocols.
Copyright American Society of Nuclear Cardiology