title: Cardiovascular outcomes of a positive nuclear stress test but negative coronary angiography in a multiethnic male predominant cohort.
abstract: BACKGROUND
  Patients presenting with chest pain and evidence of functional ischemia by myocardial perfusion imaging (MPI), but lacking commensurate angiographic disease pose a diagnostic and therapeutic dilemma. They are often dismissed as having 'false-positive MPI'. Moreover, a majority of the available long-term outcome data for it has been derived from homogenous female populations. In this study, we sought to evaluate the long-term outcomes of this presentation in a multiethnic male-predominant cohort.
  
  
  METHODS
  We retrospectively identified 47 patients who presented to our institution between 2002 and 2005 with chest pain and evidence of ischemia on MPI, but with no significant angiographic disease on subsequent cardiac catheterization (cases). The occurrence of adverse cardiovascular outcomes (chest pain, congestive heart failure, acute myocardial infarction and stroke) post-index coronary angiogram was tracked. Similar data was collected for 37 patients who also presented with chest pain, but normal MPI over the same period (controls). Overall average follow-up was over 22 months.
  
  
  RESULTS
  Fifty-three percent (26/47) of the cases had one or more of the adverse outcomes as compared with 22% (8/37) of controls (P < 0.01). Of these, 13 (50.0%) and 3 (37.5%) were males, respectively.
  
  
  CONCLUSIONS
  Ischemia on MPI is predictive of long-term adverse cardiovascular outcomes despite normal ('false-negative') coronary angiography. This appears to be gender-neutral.
authors: Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
authors: Daniel
authors: D
authors: Addison
authors: Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors: Vinita
authors: V
authors: Singh
authors: Department of Dermatology, Penn State Hershey College of Medicine, Hershey, Pennsylvania, USA.
authors: K
authors: K
authors: Okyere-Asante
authors: Department of Internal Medicine, Vanderbilt-Meharry Medical College, Nashville, Tennessee, USA.
authors: Henry
authors: H
authors: Okafor
keywords: Cardiac syndrome X; male-predominant; multiethnic