The prognosis of a normal stress-only Tc-99m myocardial perfusion imaging study.
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.
Duvall
W Lane
WL
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
Wijetunga
Melanie N
MN
Klein
Thomas M
TM
Razzouk
Louai
L
Godbold
Jim
J
Croft
Lori B
LB
Henzlova
Milena J
MJ
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
D019275:Radiopharmaceuticals; D004176:Dipyridamole; D013667:Technetium; D004298:Dopamine
J Nucl Cardiol. 2006 Nov;13(6):e80-90
17174798
J Nucl Cardiol. 2007 Jan;14(1):16-24
17276302
Am J Med. 2005 Aug;118(8):866-72
16084179
J Nucl Cardiol. 2007 Nov-Dec;14(6):e26-38
18022098
J Nucl Cardiol. 2007 Apr;14(2):153-64
17386377
Circulation. 1996 Mar 1;93(5):905-14
8598081
Am J Public Health. 1992 Aug;82(8):1145-7
1636839
Circulation. 2003 Jun 17;107(23):2900-7
12771008
IEEE Trans Med Imaging. 1994;13(4):601-9
18218538
N Engl J Med. 2009 Aug 27;361(9):849-57
19710483
IEEE Trans Med Imaging. 1982;1(2):113-22
18238264
J Am Coll Cardiol. 1998 Jul;32(1):57-62
9669249
J Am Coll Cardiol. 2010 Jan 19;55(3):221-30
19913381
J Nucl Cardiol. 2009 Mar-Apr;16(2):255-76
19242769
Circulation. 1998 Feb 17;97(6):535-43
9494023
J Nucl Med. 1994 Apr;35(4):554-7
8151374
J Comput Assist Tomogr. 1984 Apr;8(2):306-16
6608535
J Am Coll Cardiol. 2002 Mar 20;39(6):999-1004
11897442
Int J Card Imaging. 1997 Aug;13(4):331-5
9306147
J Am Coll Cardiol. 1995 Sep;26(3):639-47
7642853
Circulation. 2007 Sep 11;116(11):1290-305
17846343
J Nucl Cardiol. 2004 May-Jun;11(3):273-81
15173774
J Nucl Cardiol. 2006 Nov;13(6):e97-120
17174800
Popul Health Metr. 2004 Mar 5;2(1):2
15003125
JAMA. 2007 Jul 18;298(3):317-23
17635892