title: Stress-first single photon emission computed myocardial perfusion imaging.
abstract: BACKGROUND
  Myocardial perfusion imaging (MPI) with single photon emission tomography (SPET) is widely used in coronary artery disease evaluation. Recently major dosimetric concerns have arisen. The aim of this study was to evaluate if a pre-test scoring system could predict the results of stress SPET MPI, thus avoiding two radionuclide injections.
  
  
  METHODS
  All consecutive patients (n=309) undergoing SPET MPI during the first 6 months of 2014 constituted the study group. The scoring system is based on these characteristics: age >65 years (1 point), diabetes (2 points), typical chest pain (2 points), congestive heart failure (3 points), abnormal ECG (4 points), male gender (4 points), and documented previous CAD (5 points). The patients were divided on the basis of the prediction score into 3 classes of risk for an abnormal stress-first protocol.
  
  
  RESULTS
  An abnormal stress SPET MPI was present in 7/31 patients (23%) with a low risk score, in 24/90 (27%) with an intermediate score risk, and in 124/188 (66%) with an high score risk. ROC curve analysis showed good prediction of abnormal stress MPI.
  
  
  CONCLUSIONS
  Our results suggest an appropriate use of a pre-test clinical prediction formula of abnormal stress MPI in a routine clinical setting.
authors.affiliation: Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno, Italy.
authors.forename: C I
authors.initials: CI
authors.lastname: Aquino
authors.affiliation: A.O.U. S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Scarano
authors.affiliation: A.O.U. S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Squame
authors.affiliation: A.O.U. S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Casaburi
authors.affiliation: Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno, Italy.
authors.forename: S L
authors.initials: SL
authors.lastname: Nori
authors.affiliation: Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pace
keywords: Coronary Artery Disease; Myocardial Perfusion Imaging; Radiation Dose; Stress-First