title: Incidence of caffeine in serum of patients undergoing dipyridamole myocardial perfusion stress test by an intensive versus routine caffeine history screening.
abstract: The coronary vasodilatory effect of dipyridamole is competitively blocked by caffeine. The purposes of this study were to (1) assess the incidence of having detectable serum caffeine and (2) evaluate whether an intensive caffeine history screening strategy was superior to routine history screening before dipyridamole myocardial perfusion imaging. One hundred ninety-four patients who were randomized to an intensive or a routine screening history strategy were prospectively evaluated. Serum caffeine levels were determined in all patients. Outcomes data, including death, nonfatal myocardial infarction, and history of revascularization, were obtained at 24 months. Nearly 1 in 5 patients (19%) who screened negative by history had detectable serum caffeine. In patients who screened negative by history, there was no statistically significant difference in the percentage of caffeine seropositivity between the intensive and routine arms (16% vs 22%, respectively, p = 0.31). The incidence of combined end points of death, myocardial infarction, or revascularization was 22.9% and 7.3% in patients with and without detectable serum caffeine, respectively (p = 0.01). In conclusion, despite initial negative results on screening by history, a considerably high percentage of patients had positive serum caffeine levels. These results do not support the use of an intensive screening strategy. Detectable serum caffeine was associated with a higher incidence of adverse outcomes.
authors.affiliation: New York Methodist Hospital, Brooklyn, New York, USA.
authors.forename: Lesan T
authors.initials: LT
authors.lastname: Banko
authors.forename: Salman A
authors.initials: SA
authors.lastname: Haq
authors.forename: Debroah A
authors.initials: DA
authors.lastname: Rainaldi
authors.forename: Igor
authors.initials: I
authors.lastname: Klem
authors.forename: Jason
authors.initials: J
authors.lastname: Siegler
authors.forename: Joshua
authors.initials: J
authors.lastname: Fogel
authors.forename: Terrence J
authors.initials: TJ
authors.lastname: Sacchi
authors.forename: John F
authors.initials: JF
authors.lastname: Heitner
mesh_terms: D000368:Aged; D002110:Caffeine / Q000009:adverse effects / Q000097:blood* / Q000494:pharmacology; D003327:Coronary Disease / Q000097:blood / Q000000981:diagnostic imaging*; D004176:Dipyridamole / Q000494:pharmacology; D004347:Drug Interactions; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods; D008487:Medical History Taking / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D012016:Reference Values; D012044:Regression Analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents / Q000494:pharmacology
chemical_list: D014665:Vasodilator Agents; D002110:Caffeine; D004176:Dipyridamole