Background:The yield of myocardial perfusion imaging is low in contemporary patients with suspected coronary artery disease (CAD) selected based on American College of Cardiology Foundation/American Heart Association pretest probability estimate. We compared traditional pretest estimates of CAD probability with the prevalence of abnormal myocardial perfusion single-photon emission computed tomography (MPS).Methods:This was a cohort study from a single academic center. Consecutive stable patients without known CAD referred for stress MPS for suspected CAD between 2004 and 2011 were identified (n=15 777). Angina typicality was determined using standard criteria. Abnormal MPS perfusion was defined as a summed stress score ≥4, ischemia as summed stress score ≥4 and summed difference score ≥2, and extensive ischemia as summed difference score ≥8 using a standard, 17-segment model of the left ventricle. The pretest probability of CAD was determined using the American College of Cardiology Foundation/American Heart Association criteria.Results:Overall, 14% (n=2177) of patients had abnormal MPS of whom 11% (n=1698) had ischemia and 4% (n=684) extensive ischemia. In patients with chest pain who underwent treadmill MPS (n=4764), only 27% reported angina on the treadmill. Typical angina was associated with the highest prevalence for positive MPS (33% in men and 14% in women), ischemia (30% in men and 12% in women), and extensive ischemia (22% in men and 4% in women) when compared with other symptom categories. Prevalence of MPS abnormality was substantially lower than expected based on pretest probability estimates across most sex and age groups. In multivariable analysis, the pretest probability estimate was not an independent predictor of abnormal MPS.Conclusions:Traditional estimates of pretest probability of CAD are not predictive of MPS perfusion abnormality and overestimate its prevalence in stable patients.

中文翻译：

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传统的前测概率估计值在接受心肌灌注成像的稳定患者中的表现。

背景：根据美国心脏病学会基金会/美国心脏协会的前测概率估计结果选择的当代可疑冠状动脉疾病（CAD）患者，心肌灌注成像的获益率较低。我们将传统的CAD概率的预先测试估计值与异常心肌灌注单光子发射计算机断层扫描（MPS）的患病率进行了比较。方法：这是来自单个学术中心的一项队列研究。确定了2004年至2011年之间连续的稳定患者，其中没有已知的CAD因压力性MPS而被怀疑为CAD（n = 15 777）。使用标准标准确定心绞痛的典型性。MPS灌注异常定义为压力总分≥4，缺血为压力总分≥4，差异总分≥2，使用标准的左心室17段模型，求和差异得分≥8且发生广泛的局部缺血。根据美国心脏病学会基金会/美国心脏协会的标准确定CAD的预测概率。结果：总体上，有14％（n = 2177）的MPS异常患者中有11％（n = 1698）的缺血和4％ （n = 684）广泛缺血。在患有MPS跑步机的胸痛患者中（n = 4764），只有27％的人报告了跑步机上的心绞痛。典型的心绞痛与MPS阳性率最高有关（男性33％，女性14％），局部缺血（男性30％，女性12％）和广泛缺血（男性22％，女性4％）与其他症状类别相比。根据大多数性别和年龄组的测试前概率估计，MPS异常的患病率大大低于预期。在多变量分析中，前测概率估计值不是预测MPS异常的独立预测因素。结论：传统的CAD前测概率估计值不能预测MPS灌注异常，并过高估计了稳定患者的MPS灌注率。