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Myocardial perfusion scintigraphy: the evidence

A consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society, endorsed by the Royal College of Physicians of London and the Royal College of Radiologists

  • Review Article
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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

This review summarises the evidence for the role of myocardial perfusion scintigraphy (MPS) in patients with known or suspected coronary artery disease. It is the product of a consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society and is endorsed by the Royal College of Physicians of London and the Royal College of Radiologists. It was used to inform the UK National Institute of Clinical Excellence in their appraisal of MPS in patients with chest pain and myocardial infarction. MPS is a well-established, non-invasive imaging technique with a large body of evidence to support its effectiveness in the diagnosis and management of angina and myocardial infarction. It is more accurate than the exercise ECG in detecting myocardial ischaemia and it is the single most powerful technique for predicting future coronary events. The high diagnostic accuracy of MPS allows reliable risk stratification and guides the selection of patients for further interventions, such as revascularisation. This in turn allows more appropriate utilisation of resources, with the potential for both improved clinical outcomes and greater cost-effectiveness. Evidence from modelling and observational studies supports the enhanced cost-effectiveness associated with MPS use. In patients presenting with stable or acute chest pain, strategies of investigation involving MPS are more cost-effective than those not using the technique. MPS also has particular advantages over alternative techniques in the management of a number of patient subgroups, including women, the elderly and those with diabetes, and its use will have a favourable impact on cost-effectiveness in these groups. MPS is already an integral part of many clinical guidelines for the investigation and management of angina and myocardial infarction. However, the technique is underutilised in the UK, as judged by the inappropriately long waiting times and by comparison with the numbers of revascularisations and coronary angiograms performed. Furthermore, MPS activity levels in this country fall far short of those in comparable European countries, with about half as many scans being undertaken per year. Currently, the number of MPS studies performed annually in the UK is 1,200/million population/year. We estimate the real need to be 4,000/million/year. The current average waiting time is 20 weeks and we recommend that clinically appropriate upper limits of waiting time are 6 weeks for routine studies and 1 week for urgent studies.

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Abbreviations

Acc:

Diagnostic accuracy

ACS:

Acute coronary syndromes

BCS:

British Cardiac Society

BNCS:

British Nuclear Cardiology Society

BNMS:

British Nuclear Medicine Society

CABG:

Coronary artery bypass grafting

CHD:

Coronary heart disease

CT:

Computed X-ray tomography

LBBB:

Left bundle branch block

MI:

Myocardial infarction

MIBI:

Technetium-99m 2-methoxy-isobutyl-isonitrile

MPS:

Myocardial perfusion scintigraphy

NSF:

National Service Framework for Cardiovascular Disease

NSTEMI:

Non-ST segment elevation myocardial infarction

PCI:

Percutaneous coronary intervention

Q:

Quantitative analysis

QALY:

Quality-adjusted life-year

RCP:

Royal College of Physicians of London

RCR:

Royal College of Radiologists

Sens:

Sensitivity

Spec:

Specificity

SPET:

Single-photon emission tomography

STEMI:

ST segment elevation myocardial infarction

Tetro or tetrofosmin:

Technetium-99m 1,2-bis[bis(2-ethoxyethyl) phosphino] ethane

201Tl or thallium:

Thallium-201 thallous chloride

UA:

Unstable angina

V:

Visual analysis

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Acknowledgements

The following people either took part in the consensus conference or commented on the manuscript: Dr. Andries van Aswegen, Dr. John Barker, Dr. Jamshed Bomanji, Dr. John Buscombe, Professor Martin Buxton, Professor Paolo Camici, Professor John Camm, Professor John Cleland, Dr. Norman Campbell, Dr. Neil Garvie, Dr. Paul Hinton, Professor Peter Jarritt, Dr. Avijit Lahiri, Dr. Jim McKillop, Professor Michael Maisey, Dr. William Martin, Dr. Vahini Naidoo, Dr. Tom Nunan, Ms Vicki Parkin, Professor Dudley Pennell, Dr. Mary Prescott, Dr. Philip Thomas, Dr. Wendy Tindale and Dr. Gill Vivian. We thank the American Society of Nuclear Cardiology for its assistance, Ann Moulson of Serac Communications for assistance with writing and Sonia Crossley for administrative assistance. We also thank Amersham Health, Bristol Myers Squibb, GE Medical Systems and Philips Medical Systems for financial support for the meeting but they took no part in planning, drafting, writing or approving this document.

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Authors and Affiliations

  1. Imperial College London, Royal Brompton Hospital, Sydney St, London, SW3 6NP, UK

    S. R. Underwood

  2. Royal Brompton Hospital, Sydney St, London, SW3 6NP, UK

    C. Anagnostopoulos

  3. Georgetown University Medical Center, 3800 Reservoir Road NW, Washington DC, WA 20007-2197, USA

    M. Cerqueira

  4. Institute of Nuclear Medicine, UCL, The Middlesex Hospital, Mortimer Street, London, W1T 3AA, UK

    P. J. Ell

  5. Dudley Group of Hospitals, Wordsley Hospital, Stourbridge, West Midlands, DY8 5QX, UK

    E. J. Flint

  6. Antrim Area Hospital, Bush Road, Co Antrim, N. Ireland, UK

    M. Harbinson

  7. Harefield Hospital, Hill End Road, Harefield, Middlesex, UB9 6JH, UK

    A. D. Kelion

  8. Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK

    A. Al-Mohammad

  9. Institute of Nuclear Medicine, UCL, The Middlesex Hospital, Mortimer Street, London, W1T 3AA, UK

    E. M. Prvulovich

  10. Suite 225, Atlanta Cardiovascular Research Institute, 5665 Peachtree Dunwoody Road NE, Atlanta, Georgia, 30342, USA

    L. J. Shaw

  11. Castle Hill Hospital, Castle Road, Cottingham, E Yorkshire, HU16 5JQ, UK

    A. C. Tweddel

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Underwood, S.R., Anagnostopoulos, C., Cerqueira, M. et al. Myocardial perfusion scintigraphy: the evidence. Eur J Nucl Med Mol Imaging 31, 261–291 (2004). https://doi.org/10.1007/s00259-003-1344-5

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