The prognostic value of cardiac SPECT performed at the primary care physician's office

Background: The prognostic value of single-photon emission computed-tomography (SPECT)-myocardial perfusion imaging (MPI) is well documented. However, the utility of SPECT-MPI when performed at a low-volume primary care physician's (PCP's) office is unknown. Methods: We conducted a prospective cohort study of consecutive patients referred by their PCP to undergo a stress-MPI at the PCP's office using a mobile laboratory. Major adverse cardiovascular events (MACE) of death, myocardial infarction (MI), and coronary revascularization were prospectively tabulated using mail and telephone interviews, chart review, and social security death index. Results: One thousand three hundred ninety subjects [mean age 58 ± 13 years; 44% women] were followed for 27 ± 9 months, with a 99% complete follow-up rate. Subjects with abnormal MPI [174 (12.5%)] had significantly higher rates of all-cause mortality [5.2% vs 1.0%, P <.001], death, or MI [5.7% vs 1.5%, P =.001], and the composite of death, MI, or late revascularization (>60 days post-MPI) [12.6 vs 2.7%, P <.001]. Overall MACE risk was associated with the total perfusion abnormality burden, while the revascularization rate was related to the reversible perfusion abnormality burden. Conclusion: Contemporary SPECT-MPI performed in the setting of a PCP's office carries a robust prognostic value, similar to that reported in tertiary or large-volume practice settings.