title: The prognosis of a normal stress-only Tc-99m myocardial perfusion imaging study.
abstract: BACKGROUND
  Stress-only imaging saves time and radiation exposure, but apprehension remains about the reliability, diagnostic, and prognostic accuracy of a normal stress-only study. The objective of this study was to determine the prognosis of stress-only SPECT MPI in routine clinical practice.
  
  
  METHODS
  Patients at lower pre-test risk for CAD presenting for a Tc-99m SPECT MPI over a 2-year period underwent a stress-only protocol. If the stress images were normal (attenuation correction was routinely acquired on all patients), rest imaging was not done. Outcomes of the stress-only group were compared to a full rest-stress protocol cohort. Only patients with normal perfusion and left ventricular function, and no known CAD, were included. All-cause mortality was determined using the Social Security Death Index and specific causes of death were determined using the National Death Index. The difference in all-cause and cardiac mortality between groups in the presence of competing risks was assessed using log-normal survival models.
  
  
  RESULTS
  Out of 10,609 patients studied during the time period, 1,673 had a normal stress-only study and 3,237 had a normal rest-stress study. At one year, there were 20 total and 3 cardiac deaths (1.2% and 0.2% mortality) in the stress-only group, and 40 total and 4 cardiac deaths (1.2% and 0.1% mortality) in the rest-stress cohort. At the end of follow-up (40 +/- 9 months), there were 46 total and 7 cardiac deaths (2.7% and 0.4% mortality) in the stress-only group, and 119 total and 17 cardiac deaths (3.7% and 0.5% mortality) in the rest-stress cohort. No significant difference between the stress-only and rest-stress cohorts was found after controlling for confounding variables for both all-cause mortality (p = .94) and cardiac mortality (p = .82).
  
  
  CONCLUSIONS
  A normal stress-only MPI has an excellent short-term prognosis (both for all-cause and cardiac mortality) comparable to that of a normal rest-stress MPI study.
authors.affiliation: Mount Sinai Department of Cardiology Mount Sinai Heart, Mount Sinai Medical Center, Box 1030, One Gustave L Levy Place, New York, NY 10029, USA. william.duvall@msnyuhealth.org
authors.forename: W Lane
authors.initials: WL
authors.lastname: Duvall
authors.forename: Melanie N
authors.initials: MN
authors.lastname: Wijetunga
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Klein
authors.forename: Louai
authors.initials: L
authors.lastname: Razzouk
authors.forename: Jim
authors.initials: J
authors.lastname: Godbold
authors.forename: Lori B
authors.initials: LB
authors.lastname: Croft
authors.forename: Milena J
authors.initials: MJ
authors.lastname: Henzlova
mesh_terms: D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality; D004176:Dipyridamole / Q000494:pharmacology; D004298:Dopamine / Q000494:pharmacology; D005080:Exercise Test; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D019275:Radiopharmaceuticals; D012307:Risk Factors; D013667:Technetium; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D004176:Dipyridamole; D013667:Technetium; D004298:Dopamine
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