Combine Appropriate Use Criteria With Pretest Risk Stratification

Background: Appropriate use criteria (AUC) have been formulated in response to the rapid growth in medical imaging, in an attempt to decrease inappropriate use of expensive technology. However, AUC are only 1 step in appropriate use of imaging. Other steps include pretest clinical risk stratification and management pathways. Objective: To evaluate the relationship between AUC, risk evaluation, management, and outcome. Participants: 1199 patients (average age, 64 years; 56% men) referred for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) imaging for clinical purposes. Methods: Patients were categorized into inappropriate , uncertain , and appropriate categories according to the AUC. To risk-stratify patients, the Framingham score was used for asymptomatic patients and Bethesda angina score was used for symptomatic patients; patients were categorized as high, intermediate, or low risk. Patient management was defined as appropriate or inappropriate b more...