Nuclear Myocardial Perfusion Imaging versus Stress Echocardiography in the Preoperative Evaluation of XXXX for Kidney Transplantation.

@entity1 @entity452 @entity63 @entity453 @entity1642
UNASSIGNED: The goal of this study was to evaluate the diagnostic accuracy, cost-effectiveness and appropriate use of SPECT myocardial perfusion imaging (SMPI) versus @entity1642 ( @entity1642 ) in the preoperative evaluation of @entity1 for kidney transplantation. METHODS: A single-institution, retrospective study was performed. SMPI was performed with regadenoson and @entity1642 predominantly with @entity452 . Findings on subsequent coronary angiography were correlated. Utilizing reimbursements from the Center for Medicare Services (CMS), a cost analysis for SMPI versus @entity1642 was modeled. RESULTS: 113 @entity1 underwent imaging (53 SMPI and 60 @entity1642 ). 100% of SMPI studies were diagnostic compared to only 80% (48/60) in the @entity1642 group, and this result was statistically significant (X2 = 7.96, P < 0.01). The most common reason for a non-diagnostic test was not reaching target heart rate. In the SMPI group, 15% (8/53) had @entity63 on imaging and all had subsequent coronary angiography which confirmed obstructive coronary lesions. One @entity1 with negative SMPI had subsequent angiogram that was negative. In the @entity1642 group, 5% (3/60) had @entity63 on imaging and two had subsequent angiography, which were negative. Three of 12 @entity1 with non-diagnostic exams underwent further testing. One @entity1 had a follow-up positive SMPI but no subsequent coronary angiography. The other two @entity1 underwent coronary angiography that were negative. Of the 45 negative @entity1642 , six (13%) had angiography with positive result for obstructive @entity453 in 3/6. For modeling of cost analysis, CMS rates of  1,173 and  1,521 were utilized for SMPI and @entity1642 respectively. The model assumes that all non-diagnostic imaging would be referred for further stress testing (i.e. non-diagnostic @entity1642 would be referred for SMPI). This model estimates that initial non-invasive testing with @entity1642 versus SMPI results in 50% greater cost. CONCLUSION: For pre-operative evaluation of kidney transplantation, SMPI is more often diagnostic than @entity1642 . A cost model estimates that initial non-invasive diagnostic testing with @entity1642 would result in approximately 50% greater cost compared to SMPI. Our data also suggests that SMPI has greater diagnostic accuracy than @entity1642 . Therefore, this single institution experience supports SMPI as the more appropriate test.
