title: Discrepancy between stress electrocardiographic changes and nuclear myocardial perfusion defects in the prognostic assessment of patients with chest pain.
abstract: OBJECTIVE
  The aim of the present study was to determine the long-term prognostic value provided by the exercise electrocardiographic (ECG) response to nuclear myocardial perfusion imaging (MPI) in the evaluation of patients with chest pain, focusing on patients with a discrepancy between the two tests.
  
  
  METHODS
  A total of 1460 consecutive patients (777 female; 62.6 ± 11.4 years) undergoing exercise myocardial single-photon emission computed tomography (SPECT) were included. The endpoint was the occurrence of acute coronary syndrome, heart failure or cardiac death during follow-up.
  
  
  RESULTS
  Ischemic ECG changes were observed during stress testing in 271 patients (18.5%) and 362 patients (24.7%) had positive (abnormal) exercise MPI results. There was a discrepancy between ECG and SPECT findings in 471 patients (32.2%). During the follow-up period (14.0-39.6 months), 224 patients (15.3%) presented cardiac events. The hazard ratios (HR) of ECG and MPI results to predict events were 1.506 (95% CI: 1.113-2.039) and 10.481 (95% CI: 7.799-14.080), respectively. In patients with negative MPI, the ECG response did not predict events (HR 1.214 [95% CI: 0.646-2.282]), the same as in patients with positive MPI (HR 1.203 [95% CI: 0.848-1.705]). Only in hypertensive patients with positive SPECT did the ECG show significant prognostic value (HR 1.937 [95% CI: 1.030-3.642]). In multivariate analysis, positive MPI proved an independent long-term prognostic factor (HR 10.536 [95% CI: 7.759-14.308]), but not ECG (HR 1.356 [95% CI: 0.994-1.850]).
  
  
  CONCLUSIONS
  MPI results (normal vs. abnormal) had strong predictive value and discrepant ECG results had no significant additive prognostic value.
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Spain. Electronic address: raposeiras26@hotmail.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Raposeiras-Roubin
authors.forename: Miguel
authors.initials: M
authors.lastname: Garrido-Pumar
authors.forename: Virginia
authors.initials: V
authors.lastname: Pubul-Nuñez
authors.forename: Carlos
authors.initials: C
authors.lastname: Peña-Gil
authors.forename: Sonia
authors.initials: S
authors.lastname: Argibay-Vázquez
authors.forename: Rosa María
authors.initials: RM
authors.lastname: Agra-Bermejo
authors.forename: Emad
authors.initials: E
authors.lastname: Abu-Assi
authors.forename: Amparo
authors.initials: A
authors.lastname: Martínez-Monzonís
authors.forename: Marino
authors.initials: M
authors.lastname: Vega
authors.forename: Alvaro
authors.initials: A
authors.lastname: Ruibal-Morell
authors.forename: Jose Ramón
authors.initials: JR
authors.lastname: González-Juanatey
mesh_terms: D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
keywords: Electrocardiogram; Eletrocardiograma; Imagens de perfusão miocárdica; Myocardial perfusion imaging; Prognosis; Prognóstico; Prova de esforço; Stress test