Applicability of Appropriate Use Criteria for Myocardial Perfusion Scan in Indian Scenario

Background: Appropriate usage Criteria (AUC) for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice. Objective: To evaluate whether the medical applications of myocardial perfusion scintigraphy (MPS) in a tertiary cardiology hospital were suitable to the criteria of indications proposed by the American medical societies in 2009. Methods: We included records of patients who undergone MPS, from April 2016 up to August 2016. Demographic characteristics, patient's origin, coronary risk factors, clinical presentation, ECG, 2d echocardiogram, TMT and AUC of medical applications were studied. The criteria were evaluated by two independent cardiologists and, in doubtful cases, defined by a medical expert in MPS. Results: Total no of cases included in the study were 334 patients. Mean age was 62 ± 10 years. Of the 334 records reviewed, 201 (60.17%) studies were performed in men and 133 (39.8%) were performed in women. With ACC 2009, 168 (50.29%) were considered appropriate indications and 166 (49.70%) were considered inappropriate and uncertain indications. The AUC Sensitivity is 78.8 , Specificity of 58.7%, Positive Predictive Value of 37.5% and Negative Predictive Value of 89.8%. Conclusions: In 63(18.8%) of patients MPS investigation is used appropriately to detect the CAD according to ACC& ASNC guidelines of 2009.