Patients with adenosine-induced ST-segment depressions and normal myocardial perfusion imaging: cardiac outcomes at 24 months.
BACKGROUND
The significance of ischemic ECG changes during adenosine infusion in patients with normal myocardial perfusion imaging (MPI) is controversial. We evaluated the prevalence of, and defined the predictors for, severe coronary artery disease (CAD) in patients with such discordant findings.


METHODS
The findings of 3700 adenosine MPI studies performed at our institution between June 2005 and March 2009 were reviewed.


RESULTS
Data for 76 patients who had not previously undergone coronary revascularization and who had sufficient follow-up were analyzed; 22 (29%) were referred for coronary angiography and 10 (13%) underwent revascularization. None had left main disease and only three (14%) had multivessel disease. Diabetes mellitus was more prevalent (70% vs. 23%; P = .010) and ischemic ST-segment depressions more often lasted >5 minutes (50% vs. 15%; P = 0.021) in patients undergoing revascularization. During a 24 ± 13 month follow-up period, there were no deaths or myocardial infarctions, while an eleventh patient underwent revascularization 19 months after MPI.


CONCLUSIONS
In the presence of normal MPI, the specificity of ischemic ECG changes during adenosine infusion for the detection of severe obstructive CAD is poor, although patients with multiple coronary risk factors, particularly diabetes mellitus, should undergo further investigation.
Department of Medicine, Beth Israel Medical Center, 1st Ave. at 16th St, 20th Floor Baird Hall, New York, NY 10003, USA. jsharma8@gmail.com
Jyoti
J
Sharma
Christine
C
Roncari
Kenneth N
KN
Giedd
John T
JT
Fox
Yumiko
Y
Kanei
D000241:Adenosine / Q000494:pharmacology*; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D015899:Tomography, Emission-Computed, Single-Photon
D000241:Adenosine