Comparing two methods for determining appropriateness of myocardial perfusion imaging: Criteria from the American College of Cardiology Foundation and the American College of Radiology

Background: Appropriate use criteria (AUC) developed by the American College of Cardiology Foundation and the appropriateness criteria (AC) developed by the American College of Radiology (ACR) are two existing methods of rating appropriateness of myocardial perfusion imaging (MPI). One study found poor agreement of ratings between the two methods. However, using the most contemporary AUC from 2013, it is unknown if poor agreement still exists.

Methods: Retrospective cohort investigation comparing patients undergoing nuclear MPI between June 2011 and September 2014. The appropriateness category was determined based on the 2013 AUC (Appropriate, may be appropriate, rarely appropriate) and the 2010 ACR AC (usually appropriate, maybe appropriate, usually not appropriate). The primary outcome was the degree of the agreement between the two methods.

Results: The kappa coefficient between ACR AC and AUC was 0.32, P < 0.0001, indicating poor agreement; 40 (8%) patients were classified by the AUC but could not be classified by the ACR AC.

Conclusion: The two methods for rating the appropriateness of MPI have poor agreement; a potential for disagreement between providers and payers if only one method is used.