Societies Update Multimodality AUC: SPECT and PET Appropriate for Many Patients

June 5, 2023 — The 2023 Multimodality Appropriate Use Criteria (AUC) for the Detection and Risk Assessment of Chronic Coronary Disease is now available online. The new document updates the 2013 AUC and includes several shifts in terminology. For example, the societies have moved from "stable ischemic heart disease" to "chronic coronary disease (CCD)," where CCD includes any manifestation of coronary artery disease other than active acute coronary syndrome. The new document also recognizes that CCD may or may not be symptomatic.  

Led by the American College of Cardiology and endorsed by 10 other cardiology organizations, including ASNC, the document provides a series of charts that collectively examine 64 common clinical scenarios, each color-coded to show how experts rated the various imaging modalities for use in that scenario. Green = "Appropriate"; Yellow = "May be appropriate"; Red = "Rarely appropriate."  

The writing group, co-chaired by David E. Winchester, MD, MS, FASNC, and David J. Maron, MD, notes the AUC "should not replace clinician judgment and practice experience, but should function as tools to improve patient care and health outcomes in a cost-effective manner."   

As in other AUC documents, this publication shows how more than one testing modality may be appropriate in any given clinical scenario and does not rank modalities with regard to appropriateness. "As PatientFirst imagers, we believe that diagnostic imaging recommendations should be based on appropriate use and centered on the patient to provide the best clinical information to guide management decisions," says ASNC President Mouaz H. Al-Mallah, MD, MSc, FASNC. "The new multimodality AUC re-emphasize the value of SPECT and PET in patient-centered imaging, confirming that nuclear stress MPI remains a highly relevant, reliable modality supported by an extensive evidence base."  

The new AUC recognize the appropriateness of SPECT and PET MPI in patients with – 

• Likely anginal symptoms;  
• Prior coronary artery revascularization with anginal or anginal-equivalent symptoms; 
• A prior anatomic test (catheterization or CCTA) that is inconclusive or shows moderate stenosis; 
• A coronary artery calcium score of 100 or higher; or   
• New-onset heart failure. 

For more information: www.asnc.org 

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