Advertisement






Click here for more guidelines.
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2008; 51:1283-1289, doi:10.1016/j.jacc.2007.10.064
© 2008 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (17)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gibbons, R. J.
Right arrow Articles by McCully, R. B.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Gibbons, R. J.
Right arrow Articles by McCully, R. B.
Related Collections
Right arrowRelated Articles

CLINICAL RESEARCH: CARDIAC IMAGING

Application of Appropriateness Criteria to Stress Single-Photon Emission Computed Tomography Sestamibi Studies and Stress Echocardiograms in an Academic Medical Center

Raymond J. Gibbons, MD, FACC*,*, Todd D. Miller, MD, FACC*, David Hodge, MSc{dagger}, Lynn Urban{dagger}, Philip A. Araoz, MD{ddagger}, Patricia Pellikka, MD, FACC* and Robert B. McCully, MD, FACC*

* Division of Cardiovascular Diseases, Department of Medicine, Mayo Foundation, Mayo Clinic, Rochester, Minnesota
{dagger} Department of Biostatistics, Mayo Foundation, Mayo Clinic, Rochester, Minnesota
{ddagger} Department of Radiology, Mayo Foundation, Mayo Clinic, Rochester, Minnesota.

Manuscript received July 16, 2007; revised manuscript received September 27, 2007, accepted October 23, 2007.

* Reprint requests and correspondence: Dr. Raymond J. Gibbons, Mayo Clinic, Gonda 5, 200 First Street SW, Rochester, Minnesota 55905. (Email: gibbons.raymond{at}mayo.edu).

Objectives: The purpose of this study was to apply published appropriateness criteria for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in a single academic medical center.

Background: The American College of Cardiology Foundation (ACCF) and the American Society of Nuclear Cardiology (ASNC) have developed appropriateness criteria for stress SPECT MPI to address concern about the growth in cardiac imaging studies.

Methods: We retrospectively examined 284 patients who underwent stress SPECT MPI and 298 patients who underwent stress echocardiography before publication of these criteria.

Results: The overall level of agreement in characterizing appropriateness between 2 experienced cardiovascular nurse abstractors was modest (kappa = 0.56), but noticeably poorer (kappa = 0.27) for patients with previous SPECT or echo studies. Similar percentages of each imaging modality were assigned to the 3 appropriateness categories: 64% of stress SPECT and 64% of stress echo studies were classified appropriate; 11% of stress SPECT and 9% of stress echo were of uncertain appropriateness; and 14% of stress SPECT and 18% of stress echo were inappropriate. Of the inappropriate studies, 88% were performed for 1 of 4 indications. Approximately 10% of the patients were unclassifiable.

Conclusions: Application of existing SPECT MPI appropriateness criteria is demanding and requires an established database or detailed data collection, as well as a number of assumptions. Fourteen percent of stress SPECT studies and 18% of stress echo studies were performed for inappropriate reasons. Quality improvement efforts directed at reducing the number of these inappropriate studies may improve efficiency in the health care system.

Abbreviations and Acronyms
  ACC/AHA = American College of Cardiology/American Heart Association
  ACCF = American College of Cardiology Foundation
  ASNC = American Society of Nuclear Cardiology
  CI = confidence interval
  MPI = myocardial perfusion imaging
  PCI = percutaneous coronary intervention
  SPECT = single-photon emission computed tomography


Related Articles

Is Appropriateness Appropriate?
Robert O. Bonow
J. Am. Coll. Cardiol. 2008 51: 1290-1291. [Full Text] [PDF]

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 51: A29-A30. [Full Text] [PDF]



This article has been cited by other articles:


Home page
J Am Coll CardiolHome page
R. C. Hendel, D. S. Berman, M. F. Di Carli, P. A. Heidenreich, R. E. Henkin, P. A. Pellikka, G. M. Pohost, and K. A. Williams
ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine Endorsed by the American College of Emergency Physicians
J. Am. Coll. Cardiol., June 9, 2009; 53(23): 2201 - 2229.
[Full Text] [PDF]


Home page
CirculationHome page
CARDIAC RADIONUCLIDE IMAGING WRITING GROUP, R. C. Hendel, D. S. Berman, M. F. Di Carli, P. A. Heidenreich, R. E. Henkin, P. A. Pellikka, G. M. Pohost, and K. A. Williams
ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine: Endorsed by the American College of Emergency Physicians
Circulation, June 9, 2009; 119(22): e561 - e587.
[Full Text] [PDF]


Home page
Circ Cardiovasc ImagingHome page
R. B. McCully, P. A. Pellikka, D. O. Hodge, P. A. Araoz, T. D. Miller, and R. J. Gibbons
Applicability of Appropriateness Criteria for Stress Imaging: Similarities and Differences Between Stress Echocardiography and Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging Criteria
Circ Cardiovasc Imaging, May 1, 2009; 2(3): 213 - 218.
[Abstract] [Full Text] [PDF]


Home page
Heart AsiaHome page
T Chua
The evolving role of molecular imaging for coronary artery disease: where do we stand today?
Heart Asia, March 6, 2009; 2009(2): 1 - 5.
[Abstract] [Full Text] [PDF]


Home page
Circ Cardiovasc Qual OutcomesHome page
G. W. Neuberg
The Cost of End-of-Life Care: A New Efficiency Measure Falls Short of AHA/ACC Standards
Circ Cardiovasc Qual Outcomes, March 1, 2009; 2(2): 127 - 133.
[Full Text] [PDF]


Home page
J Am Coll Cardiol ImgHome page
P. S. Douglas, J. Chen, L. Gillam, R. Hendel, W. G. Hundley, F. Masoudi, M. R. Patel, and E. Peterson
Achieving Quality in Cardiovascular Imaging II: proceedings from the Second American College of Cardiology -- Duke University Medical Center Think Tank on Quality in Cardiovascular Imaging.
J. Am. Coll. Cardiol. Img., February 1, 2009; 2(2): 231 - 240.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
A. N. DeMaria, O. Ben-Yehuda, J. J. Bax, G. K. Feld, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, S. M. Narayan, D. J. Sahn, et al.
Highlights of the Year in JACC 2008.
J. Am. Coll. Cardiol., January 27, 2009; 53(4): 373 - 398.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
R. J. Gibbons, P. A. Araoz, and E. E. Williamson
The year in cardiac imaging.
J. Am. Coll. Cardiol., January 6, 2009; 53(1): 54 - 70.
[Full Text] [PDF]


Home page
Mayo Clin Proc.Home page
W. K. Freeman and R. J. Gibbons
Perioperative Cardiovascular Assessment of Patients Undergoing Noncardiac Surgery
Mayo Clin. Proc., January 1, 2009; 84(1): 79 - 90.
[Abstract] [Full Text] [PDF]


Home page
Br. J. Radiol.Home page
G BEDETTI, N BOTTO, M G ANDREASSI, C TRAINO, E VANO, and E PICANO
Cumulative patient effective dose in cardiology
Br. J. Radiol., September 1, 2008; 81(969): 699 - 705.
[Abstract] [Full Text] [PDF]


Home page
ANN INTERN MEDHome page
H. Hemingway, R. Chen, C. Junghans, A. Timmis, S. Eldridge, N. Black, P. Shekelle, and G. Feder
Appropriateness Criteria for Coronary Angiography in Angina: Reliability and Validity
Ann Intern Med, August 19, 2008; 149(4): 221 - 231.
[Abstract] [Full Text] [PDF]


Home page
ANN INTERN MEDHome page
D. P. Faxon
Assessing Appropriateness of Coronary Angiography: Another Step in Improving Quality
Ann Intern Med, August 19, 2008; 149(4): 276 - 278.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
R. O. Bonow
Is Appropriateness Appropriate?
J. Am. Coll. Cardiol., April 1, 2008; 51(13): 1290 - 1291.
[Full Text] [PDF]



 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement