Document Detail

Comparison of long-term mortality risk following normal exercise vs adenosine myocardial perfusion SPECT.
MedLine Citation:
PMID:  21076898     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: A higher frequency of clinical events has been observed in patients undergoing pharmacological vs exercise myocardial perfusion single-photon emission computed tomography (SPECT). While this difference is attributed to greater age and co-morbidities, it is not known whether these tests also differ in prognostic ability among patients with similar clinical profiles.
METHODS AND RESULTS: We assessed all-cause mortality rates in 6,069 patients, followed for 10.2 ± 1.7 years after undergoing exercise or adenosine SPECT. We employed propensity analysis to match exercise and adenosine subgroups by age, gender, symptoms, and coronary risk factors. Within our propensity-matched cohorts, adenosine patients had an annualized mortality rate event rates that was more than twice that of exercise patients (3.9% vs 1.6%, P < .0001). Differences in mortality persisted among age groups, including those <55 years old. In the exercise cohort, mortality was inversely related to exercise duration, with comparable mortality noted for patients exercising <3 min and those undergoing adenosine testing.
CONCLUSIONS: Among patients with normal stress SPECT tests, those undergoing adenosine testing manifest a mortality rate that is substantially higher than that observed among adequately exercising patients, but comparable to that observed among very poorly exercising patients. This elevated risk underscores an important challenge for managing patients undergoing pharmacological stress testing.
Alan Rozanski; Heidi Gransar; Sean W Hayes; John D Friedman; Rory Hachamovitch; Daniel S Berman
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-11-13
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  17     ISSN:  1532-6551     ISO Abbreviation:  J Nucl Cardiol     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-04-06     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  999-1008     Citation Subset:  IM    
Division of Cardiology, St. Lukes Roosevelt Hospital, New York, NY, USA.
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MeSH Terms
Adenosine / chemistry*
Coronary Artery Disease / diagnosis*,  mortality*
Exercise Test / adverse effects,  methods
Middle Aged
Myocardium / pathology*
Tomography, Emission-Computed, Single-Photon / methods*
Reg. No./Substance:
Comment In:
J Nucl Cardiol. 2010 Dec;17(6):983-4   [PMID:  21042900 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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