Arq Bras Cardiol: Imagem cardiovasc. 2021; 34(3): eabc189

Appropriate Use of Myocardial Perfusion Scintigraphy Criteria for Assessing Asymptomatic Patients with High Cardiovascular Risk or Known Coronary Disease

Vinicius Silva Freire

Alvarenga

, Paola Emanuela Poggio

Smanio

DOI: 10.47593/2675-312X/20213403eabc189

Abstract

Background:

The use of myocardial perfusion scintigraphy in asymptomatic patients remains restricted to very specific clinical situations, many of which are addressed in the appropriate use criteria (AUC) for myocardial perfusion scintigraphy.

Objective:

To critically analyze the application of these criteria in indicating the tests performed in asymptomatic patients of the Dante Pazzanese Institute of Cardiology, a population that is notably at high cardiovascular risk.

Methods:

The study selected asymptomatic patients undergoing myocardial perfusion scintigraphy to investigate ischemia. Indications for tests were classified as appropriate, inappropriate, or uncertain. A fixed low uptake, transient low uptake, or transient ischemic dilation were considered changed results. The statistical analysis assessed the correlation between the degree of recommendation of indications and the presence of changed test results.

Results:

From an initial selection of 2,999 medical records, 490 were considered asymptomatic and included according to the previously established inclusion criteria. Only 9.8% of the indications were inappropriate, while 61.4% were appropriate and 28.8% were uncertain. Fixed low uptake of the radiopharmaceutical occurred in 43.5% of cases versus transient low uptake in 16.1%. An appropriate or uncertain test request was a predictor of a changed test result in this population.

Conclusion:

The use of AUC for myocardial perfusion scintigraphy proved effective at predicting abnormal test results in an asymptomatic population at high cardiovascular risk, especially patients with uncertain indications, which may mean that some of the indications considered uncertain may be appropriate for a population at high cardiovascular risk.