Skip to main content
PMC home page
Heart logoLink to Heart
. 2004 Aug;90(Suppl 5):v34–v36. doi: 10.1136/hrt.2003.019133

Myocardial perfusion scintigraphy and cost effectiveness of diagnosis and management of coronary heart disease

S Underwood, L Shaw
PMCID: PMC1876325  PMID: 15254007

Full Text

The Full Text of this article is available as a PDF (91.9 KB).

Figure 1.

Figure 1

Open in a new tab

 Pre-and post-test likelihood of CHD calculated using Bayesian principles for the exercise ECG and MPS, using sensitivities of 68% and 92%, respectively, and specificities of 77% and 88%, respectively. The curved lines from top to bottom represent MPS+, ECG+, ECG– and MPS–.

Figure 2.

Figure 2

Open in a new tab

 Two year costs of diagnosis (dark grey) and management (light grey) in patients without CHD but presenting with stable chest pain syndromes, according to strategy of investigation and type of hospital. The strategies of investigation are: (1) exECG-angio; (2) exECG-MPS-angio; (3) MPS-angio; (4) angio. Angio, angiography; exECG, exercise ECG; MPS, myocardial perfusion scintigraphy. MPS = regular user of MPS; non-MPS = occasional user of MPS.2

Figure 3.

Figure 3

Open in a new tab

 Two and a half year costs of diagnosis (dark grey) and management (light grey) in 11 372 patients presenting with stable chest pain syndromes who underwent initial angiography or MPS with selective angiography, according to low, intermediate or high pre-test likelihood of CHD.12

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bateman T. M. Nuclear cardiology in private practice. J Nucl Cardiol. 1997 Mar-Apr;4(2 Pt 2):S184–S188. doi: 10.1016/s1071-3581(97)90100-8. [DOI] [PubMed] [Google Scholar]
  2. Garber A. M., Solomon N. A. Cost-effectiveness of alternative test strategies for the diagnosis of coronary artery disease. Ann Intern Med. 1999 May 4;130(9):719–728. doi: 10.7326/0003-4819-130-9-199905040-00003. [DOI] [PubMed] [Google Scholar]
  3. Goldman L., Garber A. M., Grover S. A., Hlatky M. A. 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 6. Cost effectiveness of assessment and management of risk factors. J Am Coll Cardiol. 1996 Apr;27(5):1020–1030. doi: 10.1016/0735-1097(96)87734-5. [DOI] [PubMed] [Google Scholar]
  4. Goldman L., Weinstein M. C., Goldman P. A., Williams L. W. Cost-effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of coronary heart disease. JAMA. 1991 Mar 6;265(9):1145–1151. [PubMed] [Google Scholar]
  5. Holmes David R., Jr, Gersh Bernard J. And the answer is, it doesn't much matter. Circulation. 2002 Jul 2;106(1):11–13. doi: 10.1161/01.cir.0000024293.71103.3a. [DOI] [PubMed] [Google Scholar]
  6. Kuntz K. M., Fleischmann K. E., Hunink M. G., Douglas P. S. Cost-effectiveness of diagnostic strategies for patients with chest pain. Ann Intern Med. 1999 May 4;130(9):709–718. doi: 10.7326/0003-4819-130-9-199905040-00002. [DOI] [PubMed] [Google Scholar]
  7. Lee Dong Soo, Jang Myoung Jin, Cheon Gi Jeong, Chung June-Key, Lee Myung Chul. Comparison of the cost-effectiveness of stress myocardial SPECT and stress echocardiography in suspected coronary artery disease considering the prognostic value of false-negative results. J Nucl Cardiol. 2002 Sep-Oct;9(5):515–522. doi: 10.1067/mnc.2002.125217. [DOI] [PubMed] [Google Scholar]
  8. Maddahi J., Gambhir S. S. Cost-effective selection of patients for coronary angiography. J Nucl Cardiol. 1997 Mar-Apr;4(2 Pt 2):S141–S151. doi: 10.1016/s1071-3581(97)90093-3. [DOI] [PubMed] [Google Scholar]
  9. Mark Daniel B., Shaw Leslee J., Lauer Michael S., O'Malley Patrick G., Heidenreich Paul. 34th Bethesda Conference: Task force #5--Is atherosclerosis imaging cost effective? J Am Coll Cardiol. 2003 Jun 4;41(11):1906–1917. doi: 10.1016/s0735-1097(03)00362-0. [DOI] [PubMed] [Google Scholar]
  10. Patterson R. E., Eng C., Horowitz S. F., Gorlin R., Goldstein S. R. Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease. J Am Coll Cardiol. 1984 Aug;4(2):278–289. doi: 10.1016/s0735-1097(84)80214-4. [DOI] [PubMed] [Google Scholar]
  11. Scanlon P. J., Faxon D. P., Audet A. M., Carabello B., Dehmer G. J., Eagle K. A., Legako R. D., Leon D. F., Murray J. A., Nissen S. E. ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol. 1999 May;33(6):1756–1824. doi: 10.1016/s0735-1097(99)00126-6. [DOI] [PubMed] [Google Scholar]
  12. Shaw L. J., Eisenstein E. L., Hachamovitch R., Heller G. V., Miller D. D. A primer of biostatistic and economic methods for diagnostic and prognostic modeling in nuclear cardiology: Part II. J Nucl Cardiol. 1997 Jan-Feb;4(1 Pt 1):52–60. doi: 10.1016/s1071-3581(97)90049-0. [DOI] [PubMed] [Google Scholar]
  13. Shaw L. J., Hachamovitch R., Berman D. S., Marwick T. H., Lauer M. S., Heller G. V., Iskandrian A. E., Kesler K. L., Travin M. I., Lewin H. C. The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of Noninvasive Diagnosis (END) Multicenter Study Group. J Am Coll Cardiol. 1999 Mar;33(3):661–669. doi: 10.1016/s0735-1097(98)00606-8. [DOI] [PubMed] [Google Scholar]
  14. Shaw L. J., Hachamovitch R., Cohen M., Berman D. S., Borges-Neto S., Udelson J. E., Heller G. V., Eisenstein E. L., Eagle K. A., Hendel R. C. Cost implications of selective preoperative risk screening in the care of candidates for peripheral vascular operations. Am J Manag Care. 1997 Dec;3(12):1817–1827. [PubMed] [Google Scholar]
  15. Underwood S. R., Godman B., Salyani S., Ogle J. R., Ell P. J. Economics of myocardial perfusion imaging in Europe--the EMPIRE Study. Eur Heart J. 1999 Jan;20(2):157–166. doi: 10.1053/euhj.1998.1196. [DOI] [PubMed] [Google Scholar]
  16. Wong J. B., Sonnenberg F. A., Salem D. N., Pauker S. G. Myocardial revascularization for chronic stable angina. Analysis of the role of percutaneous transluminal coronary angioplasty based on data available in 1989. Ann Intern Med. 1990 Dec 1;113(11):852–871. doi: 10.7326/0003-4819-113-11-852. [DOI] [PubMed] [Google Scholar]
  17. Wong Y., Rodwell A., Dawkins S., Livesey S. A., Simpson I. A. Sex differences in investigation results and treatment in subjects referred for investigation of chest pain. Heart. 2001 Feb;85(2):149–152. doi: 10.1136/heart.85.2.149. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES