13N-ammonia myocardial perfusion imaging with hybrid PET/CT: impact on clinical decision-making and cost-effectiveness

Abstract

To determine the impact of 13N-ammonia myocardial perfusion positron emission tomography-computed tomography (PET/CT) hybrid imaging on clinical decision-making and its cost-effectiveness. Methods: One hundred consecutive patients (28 women, 72 men; mean age 60.9�12.0 years; range 24-85 years) underwent 13N-ammonia PET/CT (CT was only used for attenuation correction) scanning to assess myocardial perfusion in patients with known (n=79) or suspected (n=8) coronary artery disease (CAD), or for suspected small vessel disease (SVD)(n=13). Prior to PET/CT the referring physician was asked to determine patient treatment if PET/CT would not be available. Four weeks after PET/CT patient management was re-assessed for each patient individually. Results: Prior to PET/CT management strategies would have been: diagnostic angiography (62/100 patients), percutaneous coronary intervention (PCI) (6/100), coronary artery bypass grafting (CABG) (3/100), transplantation (1/100), or conservative medical treatment (28/100). After PET/CT scanning treatment strategies were altered in 78 patients leading to: diagnostic angiography (0/100), PCI (20/100), CABG (3/100), transplantation (1/100), or conservative medical treatment (76/100). Patient management followed the recommendations of PET/CT findings in 97% of the cases. Cost-effectiveness analysis revealed lower costs of $273/patient as a result of PET/CT scanning. Conclusion: In a population with a high prevalence of CAD, PET/CT is cost-effective and has an important impact on patient management