Abstract:
BACKGROUND:Appropriate use criteria (AUC) for stress single-photon emission computed tomography (SPECT) are only one step in appropriate use of imaging. Other steps include pretest clinical risk evaluation and optimal management responses. We sought to understand the link between AUC, risk evaluation, management, and outcome. METHODS:We used AUC to classify 1,199 consecutive patients (63.8 ± 12.5 years, 56% male) undergoing SPECT as inappropriate, uncertain, and appropriate. Framingham score for asymptomatic patients and Bethesda angina score for symptomatic patients were used to classify patients into high (≥5%/y), intermediate, and low (≤1%/y) risk. Subsequent patient management was defined as appropriate or inappropriate based on the concordance between management decisions and the SPECT result. Patients were followed up for a median of 4.8 years, and cause of death was obtained from the social security death registry. RESULTS:Overall, 62% of SPECTs were appropriate, 18% inappropriate, and 20% uncertain (only 5 were unclassified). Of 324 low-risk studies, 108 (33%) were inappropriate, compared with 94 (15%) of 621 intermediate-risk and 1 (1%) of 160 high-risk studies (P < .001). There were 79 events, with outcomes of inappropriate patients better than uncertain and appropriate patients. Management was appropriate in 986 (89%), and appropriateness of patient management was unrelated to AUC (P = .65). CONCLUSION:Pretest clinical risk evaluation may be helpful in appropriateness assessment because very few high-risk patients are inappropriate, but almost half of low-risk patients are inappropriate or uncertain. Appropriate patient management is independent of appropriateness of testing.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Aldweib N,Negishi K,Seicean S,Jaber WA,Hachamovitch R,Cerqueira M,Marwick THdoi
10.1016/j.ahj.2013.06.003subject
Has Abstractpub_date
2013-09-01 00:00:00pages
581-8issue
3eissn
0002-8703issn
1097-6744pii
S0002-8703(13)00375-Xjournal_volume
166pub_type
杂志文章abstract:BACKGROUND:Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glyc...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2015.02.002
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:The use of vascular closure devices (VCDs) for the reduction of access site complications following percutaneous coronary intervention (PCI) remains controversial. Patients undergoing primary PCI for acute ST-segment elevation myocardial infarction (STEMI) are at high risk of femoral artery complications. A ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2011.03.009
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND:Prescribing rate control medications with or without antiarrhythmic drugs is often the first course treatment for atrial fibrillation (AF). Clinical trial data suggest that antiarrhythmic drugs are only marginally effective and have multiple drawbacks, whereas rate control alone is sufficient for most patien...
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doi:10.1016/j.ahj.2014.03.024
更新日期:2014-07-01 00:00:00
abstract::Estimating left ventricular wall stress has recognized applications, but formulae for global stress cannot be applied to ischemic ventricles. A mathematic method for estimating regional stress in infarcted ventricles has been described. The hypothesis tested was that exercise-induced ischemia increases end-systolic wa...
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journal_title:American heart journal
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doi:10.1067/mhj.2001.118740
更新日期:2001-12-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2011.10.009
更新日期:2012-02-01 00:00:00
abstract::Potential antiarrhythmic effects of calcium (slow-channel)-blocking drugs ca be indirect or direct. The indirect effect would affect ischemia-induced arrhythmias by improving myocardial perfusion or decreasing myocardial oxygen consumption. The direct effect would affect the electrical activity of the sinoatrial (SA) ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(82)90476-8
更新日期:1982-04-01 00:00:00
abstract:BACKGROUND:Galectin-3, a β-galactoside binding lectin involved in important regulatory roles in adhesion, inflammation, immunity, and fibrosis, may be relevant to atrial fibrillation (AF) etiology. METHODS:We included 8,436 participants free of AF at baseline (1996-1998) and with measures of plasma galectin-3 from the...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2017.07.001
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pub_type: 杂志文章
doi:10.1016/0002-8703(84)90542-8
更新日期:1984-07-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1067/mhj.2000.109979
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.06.029
更新日期:2005-05-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2007.07.035
更新日期:2007-12-01 00:00:00
abstract::The serum chromium in 45 subjects with no clinical evidence of ischemic heart disease was found to be 1.71 parts per billion (ppb) (S.E. +/- 0.14). In 34 patients with a previously documented myocardial infarction, it was 1.84 ppb (S.E. +/- 0.18). The difference was not significant nor was there any difference with ag...
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pub_type: 杂志文章
doi:10.1016/0002-8703(80)90734-6
更新日期:1980-05-01 00:00:00
abstract:BACKGROUND:Previous research suggests that after coronary artery bypass graft (CABG) surgery, women fare worse than men. This study investigates sex differences in depression during recovery from CABG surgery. METHODS:We followed 137 patients (72 men, 65 women) undergoing elective isolated first CABG surgery between J...
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pub_type: 杂志文章
doi:10.1016/j.ahj.2005.05.005
更新日期:2005-11-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90425-1
更新日期:1975-10-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2006.02.016
更新日期:2006-09-01 00:00:00
abstract::M-mode echocardiographic records of 26 patients with surgically proven complete atrioventricular canal defect were reviewed. Fragmentation of the interventricular septum and anterior displacement of the mitral annulus into the left ventricular outflow tract were noted in all patients. In 25 of 26 a common atrioventric...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(81)90228-3
更新日期:1981-05-01 00:00:00
abstract:BACKGROUND:Stroke prevention in anticoagulation-naïve patients with atrial fibrillation undergoing cardioversion has not been systematically studied. OBJECTIVE:To determine outcomes in anticoagulation-naïve patients (defined as those receiving an anticoagulant for <48 hours during the index episode of atrial fibrillat...
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pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2016.06.008
更新日期:2016-09-01 00:00:00
abstract::Plasma catecholamine levels were determined in 26 cases of uncomplicated myocardial infarction within 24 hours of onset of acute chest pain. Blood samples were collected at time of entry and at 4-hour intervals during the 48 hours following admission. Average values of plasma catecholamines within 1 hour of onset of p...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(79)90278-3
更新日期:1979-11-01 00:00:00
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journal_title:American heart journal
pub_type: 临床试验,杂志文章
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更新日期:1985-08-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/0002-8703(89)90404-3
更新日期:1989-06-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2017.08.012
更新日期:2017-12-01 00:00:00
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pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2017.06.008
更新日期:2017-09-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2010.06.015
更新日期:2010-10-01 00:00:00
abstract::Resting measurements of left ventricular systolic function do not reliably predict exercise capacity in patients with cardiac disease. Therefore left ventricular filling shortly after a myocardial infarction was prospectively studied to determine whether it could predict subsequent exercise time. Consecutive patients ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(05)80086-9
更新日期:1990-01-01 00:00:00
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journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1987-09-01 00:00:00
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journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1999-09-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.03.062
更新日期:2005-10-01 00:00:00
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journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0002-8703(98)70024-9
更新日期:1998-10-01 00:00:00