Introduction
Materials and methods
Survey and data management
Estimated effective doses
Statistical analysis
Results
MPS patient figures and utilization data from cardiology
2005 | 2006 | 2007 | 2008 | 2009 | 2012 | |
---|---|---|---|---|---|---|
MPS patients (survey) | 112,136 | 108,939 | 114,374 | 99,879 | 98,253 | 105,941 |
Total MPS patientsa
| 224,272 | 217,878 | 228,748 | 199,758 | 196,506 | 211,882 |
MPS pmp | 2,720 | 2,640 | 2,770 | 2,420 | 2,380 | 2,580 |
No. of centres | 356 | 353 | 370 | 312 | 292 | 278 |
Mean MPS | 315 | 309 | 309 | 320 | 336 | 381 |
Median MPS | 160 | 144 | 141 | 147 | 163 | 179 |
< 50 MPS/year | 18.5 % | 28.6 % | 25.4 % | 26.9 % | 23.3 % | 20.9 % |
> 1,000 MPS/year | 7.6 % | 8.5 % | 7.6 % | 8.7 % | 8.6 % | 10.4 % |
2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | |
---|---|---|---|---|---|---|---|---|
Angiography | 772,137 | 806,533 | 832,420 | 851,517 | 864,858 | 881,514 | 870,282 |
a
|
Angiography pmp | 9,370 | 9,800 | 10,130 | 10,380 | 10,400 | 10,690 | 10,630 |
a
|
Angiography/MPS | 3.4 | 3.7 | 3.6 | 4.3 | 4.4 | – | – | 4.1b
|
Revascularization (total) | 338,300 | 355,552 | 363,054 | 365,777 | 368,661 | 381,865 | 383,953 |
a
|
PTCA | 270,964 | 291,050 | 299,690 | 304,719 | 310,166 | 325,872 | 328,654 |
a
|
Bypass | 67,336 | 64,502 | 63,364 | 61,058 | 58,495 | 55,993 | 55,299 |
a
|
Angiography/revascularization | 2.3 | 2.3 | 2.3 | 2.3 | 2.3 | 2.3 | 2.3 |
a
|
Revascularization/MPS | 0.66 | 0.61 | 0.63 | 0.55 | 0.53 | – | – | 0.55b
|
Individual changes in referral behaviour and competitive methods
2006 | 2007 | 2012 | |
---|---|---|---|
Unknown | 31 % | 32 % | 22 % |
No change | 45 % | 40 % | 29 % |
More |
a
|
a
| 27 % |
Less | 24 % | 28 % | 21 % |
Less by | |||
Cardiac MRI | 30 % | 23 % | 22 % |
Stress echo | 18 % | 16 % | 12 % |
Angiography | 8 % | 11 % | 15 % |
Cardiac CT | 6 % | 7 % | 3 % |
More than 1 method | 38 % | 43 % | 32 % |
Unknown |
a
|
a
| 16 % |
Protocols, radiopharmaceuticals and effective doses
2005 | 2006 | 2007 | 2008 | 2009 | 2012 |
p value | ||
---|---|---|---|---|---|---|---|---|
Protocols |
201Tl | 20 % | 15 % | 17 % | 12 % | 11 % | 5 % | <0.001 |
99mTc stress only | 15 % | 14 % | 12 % | 15 % | 13 % | 16 % | 0.006 | |
99mTc 2-day | 61 % | 47 % | 46 % | 45 % | 47 % | 52 % | <0.001 | |
99mTc 1-day | 22 % | 23 % | 26 % | 28 % | 25 % | 0.03 | ||
99mTc rest | 2 % | 2 % | 2 % | 2 % | 2 % | 2 % | n.s. | |
99mTc, 201Tl (hybrid) | 2 % | – | – | – | – | – | – | |
Average effective doses | Average max. patient dose (mSv) |
a
| 9.8 | 10.2 | 9.7 | 9.7 | 9.2 | <0.001 |
Mean patient dose (mSv) |
a
| 8.2 | 8.7 | 8.1 | 8.1 | 7.4 | <0.001 | |
Average min. patient dose (mSv) |
a
| 6.6 | 7.1 | 6.5 | 6.5 | 5.6 | <0.001 |
Radiopharmaceutical | Protocol | DRLa
| Administered activity range | Effective dose range | |
---|---|---|---|---|---|
Average lower level | Average upper level | ||||
(MBq) | (MBq) | (MBq) | (mSv) | ||
201Tl | 75 | 75 | 75 | 16.5 | |
99mTc-sestamibi or 99mTc-tetrofosmin | Stress only | 600 | 250 | 600 | 2.0–4.8 |
Rest only | 600 | 250 | 600 | 2.3–5.4 | |
1-day protocol | 1,000 | 250 stress, 750 rest* | 250 stress, 750 rest* | 8.8 | |
2-day protocol | 1,200 | 250 stress, 250 rest | 600 stress, 600 rest | 4.3–10.2 |
Stress techniques
2005 | 2006 | 2007 | 2008 | 2009 | 2012 |
p value | |
---|---|---|---|---|---|---|---|
Ergometry | 78 % | 73 % | 73 % | 69 % | 69 % | 61 % | <0.001 |
Adenosine | 21 % | 14 % | 18 % | 20 % | 23 % | 24 % | <0.001 |
Dipyridamole | 10 % | 9 % | 9 % | 8 % | 5 % | 0.038 | |
Regadenoson | 9 % | – | |||||
Dobutamine | 1 % | 2 % | 1 % | 1 % | 1 % | 1 % | n.s. |
Adenosine + LLEa
|
b
| 29 % | 25 % | 22 % | 32 % | 39 % | n.s. |
Dipyridamole + LLEa
|
b
| 57 % | 54 % | 61 % | 64 % | 60 % | n.s. |
Regadenoson + LLEa
| 51 % | – |
Gated SPECT and segmental scoring
2005 | 2006 | 2007 | 2008 | 2009 | 2012 |
p value | ||
---|---|---|---|---|---|---|---|---|
Gated SPECT | At stress | 32 % | 39 % | 43 % | 42 % | 55 % | 73 % | <0.001 |
At rest | 36 % | 42 % | 46 % | 46 % | 55 % | 70 % | <0.001 | |
At stress and rest | 14 % | 36 % | 37 % | 37 % | 47 % | 67 % | <0.001 | |
Centres with perfusion scoring | Always | 16 % | 22 % | 33 % | 35 % | <0.001 | ||
Intermediate | 23 % | 15 % | 16 % | 23 % | 0.011 | |||
Never | 61 % | 62 % | 52 % | 41 % | <0.001 |
MPS referrals
2005 | 2006 | 2007 | 2008 | 2009 | 2012 |
p value | |
---|---|---|---|---|---|---|---|
Ambulatory care cardiologists | 47 % | 49 % | 47 % | 50 % | 49 % | 60 % | <0.001 |
Ambulatory care internists | 17 % | 19 % | 23 % | 17 % | 23 % | 14 % | n.s. |
Inpatients | 21 % | 17 % | 15 % | 16 % | 15 % | 13 % | n.s. |
Primary care physicians | 13 % | 13 % | 12 % | 12 % | 11 % | 10 % | n.s. |
Others | 2 % | 2 % | 3 % | 5 % | 2 % | 3 % | n.s. |
Attenuation correction
2006 | 2009 | |
---|---|---|
MPS studies with AC | 7 % | 4 % |
No. of centres with CT-based AC | 8 | 12 |
No. of centres with transmission sources for AC | 18 | 17 |
No. of centres with both methods | 1 | 3 |