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Normal Stress-Only Versus Standard Stress/Rest Myocardial Perfusion Imaging: Similar Patient Mortality With Reduced Radiation Exposure

SU MIN CHANG ; NABI, Faisal ; JIAQIONG XU ; RAZA, Umara ; MAHMARIAN, John J

Journal of the American College of Cardiology, 2010-01, Vol.55 (3), p.221-230 [Peer Reviewed Journal]

New York, NY: Elsevier

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Title:
Normal Stress-Only Versus Standard Stress/Rest Myocardial Perfusion Imaging: Similar Patient Mortality With Reduced Radiation Exposure
Author: SU MIN CHANG ; NABI, Faisal ; JIAQIONG XU ; RAZA, Umara ; MAHMARIAN, John J
Subjects: Adenosine ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Body mass index ; Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography ; Cardiology ; Cardiology. Vascular system ; Cardiovascular disease ; Cohort Studies ; Confidence intervals ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - mortality ; Diabetes ; Dobutamine ; Exercise Test ; Female ; Fitness equipment ; Heart attacks ; Humans ; Hypertension ; Male ; Medical sciences ; Middle Aged ; Mortality ; Myocardial Perfusion Imaging ; Pain ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Studies ; Survival Analysis ; Young Adult
Is Part Of: Journal of the American College of Cardiology, 2010-01, Vol.55 (3), p.221-230
Notes: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
Description: The aim of this study was to determine whether a normal stress-only single-photon emission computed tomographic myocardial perfusion tomography (SPECT) study confers the same prognosis as a normal SPECT on the basis of evaluation of stress and rest images. Current guidelines recommend stress and rest imaging to confirm that a SPECT study is normal. We determined all-cause mortality in 16,854 consecutive patients who had a normal gated stress SPECT. Median follow-up was 4.5 years. A stress-only protocol was used in 8,034 patients (47.6%), whereas 8,820 (52.4%) had both stress and rest imaging. The overall unadjusted annual mortality rate in patients who had a normal SPECT with a stress-only protocol was lower than in those who required additional rest imaging (2.57% vs. 2.92%, p = 0.02). After adjustment for baseline clinical characteristics no significant differences in patient mortality were seen between the 2 imaging protocols, but the stress-only group received a 61% lower radiopharmaceutical dosage. Independent predictors of worse survival included increasing age, male sex, diabetes, history of coronary artery disease, and inability to exercise (all p < 0.001) but not the type of SPECT protocol used to image patients. Patients determined to have a normal SPECT on the basis of stress imaging alone have a similar mortality rate as those who have a normal SPECT on the basis of evaluation of both stress and rest images. Our results support that additional rest imaging is not required in patients who have a normally appearing initial stress study. A significant reduction in radiation exposure can be achieved with such an approach.
Publisher: New York, NY: Elsevier
Language: English

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Normal Stress-Only Versus Standard Stress/Rest Myocardial Perfusion Imaging: Similar Patient Mortality With Reduced Radiation Exposure

SU MIN CHANG ; NABI, Faisal ; JIAQIONG XU ; RAZA, Umara ; MAHMARIAN, John J

New York, NY: Elsevier

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