Indicação de cintilografia de perfusão do miocárdio para a detecção de doença arterial coronariana, baseada em evidências ergométricas e clínico-epidemiológicas

Abstract

Objective: To establish when the myocardial perfusion scintigraphy (MPS) should be performed based on well-defined information obtained from treadmill test results and clinical-epidemiological parameters for coronary artery disease (CAD). Methods: 2,100 patients who underwent MPS were classified according to the results of scintigraphy, the Duke score and a clinical-epidemiological score based on Framingham study. The patients with positive results on MPS were followed to define whether the results were true positives. Receiver operating characteristic (ROC) curves were used to establish the efficiency and the best Duke and clinical-epidemiological scores to define patients that should be submitted to scintigraphy. Results: It was observed that the MPS use restriction in patients with Duke score below 7.5 and/or clinical-epidemiological score above 4 could decrease the utilization of this method by 50% without exposing the patients to a significant misdiagnosis risk. Conclusion: The utilization of the Duke score and a clinical-epidemiological score to classify the patients expressively decreased the number of unnecessarily requested scintigraphies.