How Should We Interpret the Decrease in Annual Volume of Stress Imaging Tests for Evaluation of Suspected or Known Coronary Artery Disease With Fewer High-Risk Test Results?
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- coronary artery disease
- myocardial perfusion imaging
- tomography, emission-computed, single-photon
In recent years, observations related to the diminution in annual volume of stress imaging tests, the decrease in frequency of abnormal test findings, coupled with a rather high rate of normal coronary angiograms or nonobstructive coronary artery disease (CAD) at coronary angiography, following an abnormal stress imaging test, have intrigued the cardiology specialist community. Similarly, these observations have occurred simultaneously with a decrease in the cardiac event rate after testing and an overall improved prognosis in patients with CAD. Using Medicare data, Levin et al1 determined the trends in noninvasive imaging use from 2001 to 2013. Total radionuclide myocardial perfusion imaging (MPI) rates per 1000 Medicare beneficiaries rose from 63.4 in 2001 to a peak of 88.0 in 2006 but then declined every year afterward, reaching 10.8 in 2013. Rates for use of stress echocardiography held steady until 2010 and then decreased each year thereafter (12.6/1000 to 10.8/1000). McNulty et al2 investigated the temporal trends in radionuclide MPI use at Kaiser Permanente Northern California from 2000 to 2011. They found that annual rates of MPI rose steadily from 2000 to 2006 and then abruptly declined by 51% through 2011. Relative declines were greater for outpatients than inpatients and greater for individuals <65 years of age versus those ≥65 years. Interestingly, the volume of stress echocardiography was unchanged from 2007 to 2011.
See Article by Jouni et al
In 2 separate publications, the second in this issue of the journal, Jouni et al3,4 from the Mayo Clinic report a marked decrease in single-photon computed tomography (SPECT) myocardial perfusion MPI tests from 2003 to 2012 at their institution. The first study comprised patients without known prior CAD referred for SPECT MPI.3 They found that between 2001 and 2003, 2490 such tests were performed annually. By 2012, …