Normal Stress-Only Versus Standard Stress/Rest Myocardial Perfusion Imaging. Similar Patient Mortality With Reduced Radiation Exposure

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168 Scopus citations

Abstract

Objectives: The aim of this study was to determine whether a normal stress-only single-photon emission computed tomographic myocardial perfusion tomography (SPECT) study confers the same prognosis as a normal SPECT on the basis of evaluation of stress and rest images. Background: Current guidelines recommend stress and rest imaging to confirm that a SPECT study is normal. Methods: We determined all-cause mortality in 16,854 consecutive patients who had a normal gated stress SPECT. Median follow-up was 4.5 years. A stress-only protocol was used in 8,034 patients (47.6%), whereas 8,820 (52.4%) had both stress and rest imaging. Results: The overall unadjusted annual mortality rate in patients who had a normal SPECT with a stress-only protocol was lower than in those who required additional rest imaging (2.57% vs. 2.92%, p = 0.02). After adjustment for baseline clinical characteristics no significant differences in patient mortality were seen between the 2 imaging protocols, but the stress-only group received a 61% lower radiopharmaceutical dosage. Independent predictors of worse survival included increasing age, male sex, diabetes, history of coronary artery disease, and inability to exercise (all p < 0.001) but not the type of SPECT protocol used to image patients. Conclusions: Patients determined to have a normal SPECT on the basis of stress imaging alone have a similar mortality rate as those who have a normal SPECT on the basis of evaluation of both stress and rest images. Our results support that additional rest imaging is not required in patients who have a normally appearing initial stress study. A significant reduction in radiation exposure can be achieved with such an approach.

Original languageEnglish (US)
Pages (from-to)221-230
Number of pages10
JournalJournal of the American College of Cardiology
Volume55
Issue number3
DOIs
StatePublished - Jan 19 2010

Keywords

  • myocardial perfusion imaging
  • risk stratification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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