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Is there a referral bias againstcatheterization of patients withreduced left ventricular ejection fraction?

Influence of ejection fraction and inducible ischemia onpost–single-photon emission computed tomographymanagement of patients without a history of coronary artery disease

Rory Hachamovitch, MD, MSc, FACC^*, Sean W. Hayes, MD, John D. Friedman, MD, FACC, Ishac Cohen, PhD, Xingping Kang, MD, Guido Germano, PhD, FACC and Daniel S. Berman, MD, FACC^,*

^* Cardiovascular Division, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
Departments of Imaging (Division of Nuclear Medicine) and Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
Department of Medicine, UCLA School of Medicine, Los Angeles, California, USA

View larger version (15K): [in a new window]   Figure 1 Univariate relationship between the likelihood (Lk) of catheterization referral and percent of the myocardium ischemic (solid line) with 95% confidence intervals (dotted lines). Increase in likelihood, p < 0.001.

View larger version (14K): [in a new window]   Figure 2 Univariate relationship between the likelihood (Lk) of catheterization referral and gated ejection fraction (solid line) with 95% confidence intervals (dotted lines). Increase in likelihood, p < 0.001. SPECT = single-photon emission computed tomography.

View larger version (18K): [in a new window]   Figure 3 Relationship between gated ejection fraction and percent of the myocardium ischemia with respect to prediction of likelihood (Lk) of catheterization referral based on logistic regression model. Results are shown for percent of the myocardium ischemia values of 0%, 5%, 7.5%, 10%, 12.5%, 15%, 20%, and 30%. SPECT = single-photon emission computed tomography.

View larger version (47K): [in a new window]   Figure 4 Relationship between gated ejection fraction (EF) and percent of the myocardium ischemia with respect to prediction of likelihood (Lk) of revascularization (Revasc) referral based on logistic regression model. Increase in likelihood, p < 0.0001. SPECT = single-photon emission computed tomography.

View larger version (48K): [in a new window]   Figure 5 Relationship between gated ejection fraction (EF) and percent of the myocardium ischemia with respect to prediction of likelihood (Lk) of coronary artery bypass graft surgery (CABG) referral based on a logistic regression model. Increase in likelihood, p < 0.0001.

View larger version (53K): [in a new window]   Figure 6 Relationship between gated ejection fraction (EF) and percent of the myocardium ischemia with respect to prediction of likelihood (Lk) of percutaneous coronary intervention (PCI) referral based on logistic regression model. Increase in likelihood, p < 0.0001.