Myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction

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Scope: Myocardial perfusion scintigraphy for the diagnosis and management of coronary heart disease

NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE

Health Technology Appraisal

Myocardial perfusion scintigraphy for the diagnosis and management of coronary heart disease

Scope

 

Objective: To assess the clinical effectiveness and cost effectiveness of myocardial perfusion scintigraphy (MPS) for the diagnosis and management of patients with suspected and diagnosed coronary heart disease, and to provide guidance to the NHS in England and Wales. 1

The focus of this appraisal is to assess the value of the MPS procedure as part of the current pathways of clinical care in England and Wales. No comparisons between different radionuclides in terms of their effectiveness and cost?effectiveness will be made.

Background: CHD is one of the leading causes of death in England and Wales. In 2000 there were 108 000 deaths from CHD in England and Wales. The incidence of angina is hard to estimate, but might be 2-3 times this figure, with a possible prevalence of over 2 million people in the UK.2

Technology: Myocardial perfusion scintigraphy involves the intravenous administration of a radionuclide labelled tracer followed by acquisition of myocardial images using a gamma camera. The commonest form of acquisition is SPECT (Single Photon Emission Computed Tomography) and this is now often combined with ECG gating. The images provide information on myocardial viability and perfusion and function and this helps determine the presence, location, extent and severity of coronary heart disease. The technique can therefore help in the diagnosis of coronary heart disease and also in the selection of high?risk patients for referral to specialist centres for coronary angiography and possible intervention. It can also identify patients with ischaemic heart failure that will benefit from revascularisation because of the presence of hibernating myocardium.

Myocardial perfusion scintigraphy has been used in UK clinical practice for over 20 years, however the utilisation rates are below those of many other European countries, and there are long waiting?lists in some centres.

Interventions

Myocardial perfusion scintigraphy

Populations

Patients with suspected or diagnosed coronary heart disease, excluding pregnant women.

Comparators The addition of myocardial perfusion scintigraphy to other diagnosis/management strategies should be compared to the strategies excluding scintigraphy.

Current diagnostic/management strategies in the UK commonly include exercise ECG and coronary angiography.

Magnetic resonance techniques and positron emission tomography are not being considered.
Other considerations

The use of MPS for assessing the myocardial viability will not be examined.

No comparisons between different radionuclides in terms of their effectiveness and cost-effectiveness will be made.

If the evidence allows, the appraisal will attempt to identify the criteria for selecting patients for whom MPS would be particularly appropriate. Potential subgroups include people with a history of myocardial infarction and females.

If evidence allows, the use of MPS in the context of rapid access chest pain clinics will be evaluated, and consideration given to the implications for referral routes within the health services.

Service implications and training needs should be assessed. Where possible, consideration will be given to waiting times.

 

1 The Dept. of Health/National Assembly for Wales remit to the Institute is "To appraise the clinical and cost effectiveness of myocardial perfusion scintigraphy in the diagnosis and management of patients with suspected coronary heart disease."

2 Source: from the Coronary Heart Disease statistics. (2002) BHF Statistics Database available from http://www.dphpc.ox.ac.uk/bhfhprg/stats/2000/index.html

 

This page was last updated: 30 March 2010