title: Temporal trends in the frequency of inducible myocardial ischemia during cardiac stress testing: 1991 to 2009.
abstract: OBJECTIVE
  This study sought to assess whether the frequency of inducible myocardial ischemia during stress-rest single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has changed over time.
  
  
  BACKGROUND
  The prevalence of cardiac death and other clinical cardiac events have declined in recent decades, but heretofore no study has examined if there has been a temporal change in the frequency of inducible myocardial ischemia during cardiac stress testing.
  
  
  METHODS
  We assessed 39,515 diagnostic patients undergoing stress-rest MPI between 1991 and 2009. Patients were assessed for change in demographics, clinical symptoms, risk factors, and frequency of abnormal and ischemic SPECT-MPI.
  
  
  RESULTS
  There was a marked progressive decline in the prevalence of abnormal SPECT studies, from 40.9% in 1991 to 8.7% in 2009 (p < 0.001). Similarly, the prevalence of ischemic SPECT-MPI declined, from 29.6% to 5.0% (p < 0.001), as did the prevalence of severe ischemia. The decline of SPECT-MPI abnormality occurred among all age and symptom subgroups, falling to only 2.9% among recent exercising patients without typical angina. We also noted a progressive trend toward performing more pharmacological rather than exercise stress in all age and weight groups, and pharmacological stress was more likely than exercise to be associated with SPECT-MPI abnormality (odds ratio: 1.43, 95% confidence interval: 1.3 to 1.5; p < 0.001).
  
  
  CONCLUSIONS
  Over the past 2 decades, the frequency and severity of abnormal stress SPECT-MPI studies has progressively decreased. Notably, the frequency of abnormal SPECT-MPI is now very low among exercising patients without typical angina. These findings suggest the need for developing more cost-effective strategies for the initial work-up of patients who are presently at low risk for manifesting inducible myocardial ischemia during cardiac imaging procedures.
authors.affiliation: Division of Cardiology and Department of Medicine, St. Luke's Roosevelt Hospital, New York, New York, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
authors.forename: Heidi
authors.initials: H
authors.lastname: Gransar
authors.forename: Sean W
authors.initials: SW
authors.lastname: Hayes
authors.forename: James
authors.initials: J
authors.lastname: Min
authors.forename: John D
authors.initials: JD
authors.lastname: Friedman
authors.forename: Louise E J
authors.initials: LE
authors.lastname: Thomson
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
mesh_terms: D000241:Adenosine; D000367:Age Factors; D000368:Aged; D060050:Angina, Stable / Q000453:epidemiology; D015992:Body Mass Index; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000175:diagnosis; D003920:Diabetes Mellitus / Q000453:epidemiology; D004417:Dyspnea / Q000453:epidemiology; D004562:Electrocardiography; D005080:Exercise Test / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging; D011446:Prospective Studies; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
chemical_list: D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D000241:Adenosine