Appropriate-Use Criteria for Myocardial Perfusion Imaging and Prognosis

Professional societies have published criteria for use of single-photon emission computed tomography–myocardial perfusion imaging (SPECT-MPI), classifying indications as “appropriate,” “uncertain,” or “inappropriate” (J Am Coll Cardiol 2009; 53:2201). To determine whether appropriate ordering of the test is associated with greater prognostic value, researchers in Chicago stratified 1511 consecutive outpatients who were undergoing SPECT-MPI at 11 community-based practices into appropriate, uncertain, or inappropriate groups and examined outcomes for each group. Mean follow-up for major adverse cardiac events was 27 months.

SPECT-MPI results were abnormal in 167 patients (11%), and 45 patients experienced adverse cardiac events. Among the 823 …