Implementation of a cardiac PET stress program: comparison of outcomes to the preceding SPECT era
Stacey Knight, … , Jeffrey L. Anderson, Kirk U. Knowlton
Stacey Knight, … , Jeffrey L. Anderson, Kirk U. Knowlton
Published May 3, 2018
Citation Information: JCI Insight. 2018;3(9):e120949. https://doi.org/10.1172/jci.insight.120949.
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Clinical Research and Public Health Cardiology

Implementation of a cardiac PET stress program: comparison of outcomes to the preceding SPECT era

Abstract

BACKGROUND. Cardiac positron emission testing (PET) is more accurate than single photon emission computed tomography (SPECT) at identifying coronary artery disease (CAD); however, the 2 modalities have not been thoroughly compared in a real-world setting. We conducted a retrospective analysis of 60-day catheterization outcomes and 1-year major adverse cardiovascular events (MACE) after the transition from a SPECT- to a PET-based myocardial perfusion imaging (MPI) program. METHODS. MPI patients at Intermountain Medical Center from January 2011–December 2012 (the SPECT era, n = 6,777) and January 2014–December 2015 (the PET era, n = 7,817) were studied. Outcomes studied were 60-day coronary angiography, high-grade obstructive CAD, left main/severe 3-vessel disease, revascularization, and 1-year MACE-revascularization (MACE-revasc; death, myocardial infarction [MI], or revascularization >60 days). RESULTS. Patients were 64 ± 13 years old; 54% were male and 90% were of European descent; and 57% represented a screening population (no prior MI, revascularization, or CAD). During the PET era, compared with the SPECT era, a higher percentage of patients underwent coronary angiography (13.2% vs. 9.7%, P < 0.0001), had high-grade obstructive CAD (10.5% vs. 6.9%, P < 0.0001), had left main or severe 3-vessel disease (3.0% vs. 2.3%, P = 0.012), and had coronary revascularization (56.7% vs. 47.1%, P = 0.0001). Similar catheterization outcomes were seen when restricted to the screening population. There was no difference in 1-year MACE-revasc (PET [5.8%] vs. SPECT [5.3%], P = 0.31). CONCLUSIONS. The PET-based MPI program resulted in improved identification of patients with high-grade obstructive CAD, as well as a larger percentage of revascularization, thus resulting in fewer patients undergoing coronary angiography without revascularization. FUNDING. This observational study was funded using internal departmental funds.

Authors

Stacey Knight, David B. Min, Viet T. Le, Kent G. Meredith, Ritesh Dhar, Santanu Biswas, Kurt R. Jensen, Steven M. Mason, Jon-David Ethington, Donald L. Lappe, Joseph B. Muhlestein, Jeffrey L. Anderson, Kirk U. Knowlton

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Figure 1

Sixty-day coronary catheterizations and outcomes of the SPECT and PET eras.

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Sixty-day coronary catheterizations and outcomes of the SPECT and PET er...
Patients in the PET era had a higher rate of angiography, high-grade obstructive coronary artery disease (CAD), and revascularization than patients in the SPECT era. The percentage of left main and 3-vessel CAD was similar in the groups. Unadjusted χ2 tests were used to compare outcome percentages for the 2 eras (PET vs. SPECT).***P = 3.6 × 10–11 for 60-day coronary angiography, **P = 2.7 × 10–14 for high-grade obstructive CAD, †P = 1.4 × 10–13 for revascularization, and ‡P = 0.012 for left main or severe 3-vessel disease. Restricting to patients that had an angiography, the P values associated with percentage of outcomes for the 2 eras are *P = 1.8 × 10–4 for high-grade obstructive CAD, ††P = 1.2 × 10–4 for revascularization, and ‡P = 0.55 for left main or severe 3-vessel disease.