Abstract 12593: Comparison Between Appropriateness of Exercise EKG and Stress Myocardial Perfusion Imaging Based on 2013 Multimodality Appropriate Use Criteria
Introduction: The American College of Cardiology recently published 2013 multimodality Appropriate Use Criteria (AUC) for the detection and risk assessment of stable Ischemic Heart Disease. The criteria present potential diagnostic tests for common indications using a side-by-side rating system. Exercise EKG is a commonly used non-invasive test with excellent negative predictive value for coronary artery disease. The 2013 multimodality AUC are the first to define appropriate use of exercise EKG. The objective of our study was to evaluate appropriateness of exercise EKG in patients who underwent Stress Myocardial Perfusion Imaging (MPI).
Methods: A total of 403 patients who underwent stress MPI at our institute were included in the study. Each stress MPI was classified into Appropriate, May be Appropriate or Rarely Appropriate based on 2013 multimodality AUC. The exercise EKG AUC was then applied to the same cohort of patients. For patients who underwent Stress MPI for Rarely Appropriate indications, appropriateness of exercise EKG was evaluated.
Results: The mean age of the study population was 62.23±14 years (47.89% males). Out of 403 stress MPI studies, 24.31% were Rarely Appropriate based on 2013 multimodality AUC. Among the Rarely Appropriate stress MPI studies, exercise EKG was Appropriate in 69.38%. The most common indication for Rarely Appropriate stress MPI was “Evaluation of symptomatic patients with low pre-test probability of CAD with interpretable EKG and ability to exercise” (Indication 1 of AUC) accounting for 51.69% of Rarely Appropriate studies. Per 2013 multimodality AUC, exercise EKG was appropriate in all patients in this subgroup of low risk patients with interpretable EKG and ability to exercise.
Conclusion: A majority of Rarely Appropriate stress MPI studies would have been appropriate if ordered only as an exercise EKG. This study highlights another opportunity to reduce healthcare cost as well as radiation burden from unnecessary stress myocardial perfusion imaging.
Author Disclosures: A. Mahajan: None. S. Bal: None. H. Hahn: None.
- © 2014 by American Heart Association, Inc.