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The use of pre-test and post-test probability values as criteria before selecting patients to undergo coronary angiography in patients who have ischemic findings on myocardial perfusion scintigraphy [Anatol J Cardiol]
Anatol J Cardiol. 2016; 16(7): 512-519 | DOI: 10.5152/AnatolJCardiol.2015.6347  

The use of pre-test and post-test probability values as criteria before selecting patients to undergo coronary angiography in patients who have ischemic findings on myocardial perfusion scintigraphy

Nazlı Pınar Karahan Şen1, Recep Bekiş2, Ali Ceylan3, Erkan Derebek2
1Department of Nuclear Medicine, Kırklareli Government Hospital, Kırklareli- Turkey
2Departments of Nuclear Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir- Turkey
3Public Health, Faculty of Medicine, Dokuz Eylül University, İzmir- Turkey

Objective: Myocardial perfusion scintigraphy (MPS) is a diagnostic test which is frequently used in the diagnosis of coronary heart disease (CHD). MPS is generally interpreted as ischemia present or absent; however, it has a power in predicting the disease, similar to other diagnostic tests. In this study, we aimed to assist in directing the high-risk patients to undergo coronary angiography (CA) primarily by evaluating patients without prior CHD history with pre-test and post-test probabilities.
Methods: The study was designed as a retrospective study. Between January 2008 and July 2011, 139 patients with positive MPS results and followed by CA recently (<6 months) were evaluated from patient files. Patients’ pre-test probabilities based on the Diamond and Forrester method and the likelihood ratios that were obtained from the literature were used to calculate the patients’ post-exercise and post-MPS probabilities. Patients were evaluated in risk groups as low, intermediate, and high, and an ROC curve analysis was performed for the post-MPS probabilities.
Results: Coronary artery stenosis (CAS) was determined in 59 patients (42.4%). A significant difference was determined between the risk groups according to CAS, both for the pre-test and post-test probabilities (p<0.001, p=0.024). The ROC analysis provided a cut-off value of 80.4% for post-MPS probability in predicting CAS with 67.9% sensitivity and 77.8% specificity.
Conclusion: When the post-MPS probability is ≥80% in patients who have reversible perfusion defects on MPS, we suggest interpreting the MPS as “high probability positive” to improve the selection of true-positive patients to undergo CA, and these patients should be primarily recommended CA. (Anatol J Cardiol 2016; 16: 512-9)

Keywords: myocardial perfusion imaging, coronary angiography


Nazlı Pınar Karahan Şen, Recep Bekiş, Ali Ceylan, Erkan Derebek. The use of pre-test and post-test probability values as criteria before selecting patients to undergo coronary angiography in patients who have ischemic findings on myocardial perfusion scintigraphy. Anatol J Cardiol. 2016; 16(7): 512-519

Corresponding Author: Nazlı Pınar Karahan Şen, Türkiye


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