부산대학교 도서관

Background: Stress cardiac-magnetic-resonance (CMR) imaging is increasingly used in the management of patients with known or suspected coronary artery disease. Appropriate use criteria (AUC) for CMR were developed to provide guidance for physicians and payers regarding the appropriateness of this test in various clinical scenarios. However these criteria were created by expert consensus and have never been systematically validated. We sought to determine the rates of abnormal stress CMR and subsequent downstream angiography and revascularization procedures as categorized by the recently revised AUC.Methods: 168 consecutive patients undergoing stress CMR were prospectively categorized as “appropriate”, “may be appropriate”, or “rarely appropriate” based on the 2013 AUC. Patients were followed for 60 days for the endpoints of cardiac catheterization and revascularization.Results: When categorized by the 2013 AUC, 47.6% (N= 80) of stress CMRs were considered “appropriate”, 37.5% (N = 63) were classified as “may be appropriate”, and 14.9% (N = 25) were “rarely appropriate”. “Appropriate” and “may be appropriate” tests were more likely to yield abnormal perfusion or areas of delayed enhancement (DE) compared to “rarely appropriate” studies (25% vs 25.4% vs 16% respectively). The “appropriate” group had similar rates of subsequent angiography (7.5% vs 12.5%, p = 0.40) and revascularization (5.0% vs 6.3%, p = 0.73) compared to the “may be appropriate” group. In the “rarely appropriate” studies, rates of revascularization (0%) were significantly lower than in either “appropriate” or “may be appropriate” studies.Conclusions: When applying the 2013 AUC for stress CMR, “appropriate” and “may be appropriate” studies have more frequent perfusion defects and areas of DE than those classified as “rarely appropriate”. In addition, the rates of subsequent revascularization were similar for “appropriate” and “may be appropriate” categories. These findings suggest that at least some of the “may be appropriate” AUC indications require reclassification to the “appropriate” category. These observations have important implications, since the AUC are increasingly used by payers to assess the suitability of reimbursement for CMR procedures.