Document Detail


The prognosis of a normal stress-only Tc-99m myocardial perfusion imaging study.
MedLine Citation:
PMID:  20390394     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Stress-only imaging saves time and radiation exposure, but apprehension remains about the reliability, diagnostic, and prognostic accuracy of a normal stress-only study. The objective of this study was to determine the prognosis of stress-only SPECT MPI in routine clinical practice. METHODS: Patients at lower pre-test risk for CAD presenting for a Tc-99m SPECT MPI over a 2-year period underwent a stress-only protocol. If the stress images were normal (attenuation correction was routinely acquired on all patients), rest imaging was not done. Outcomes of the stress-only group were compared to a full rest-stress protocol cohort. Only patients with normal perfusion and left ventricular function, and no known CAD, were included. All-cause mortality was determined using the Social Security Death Index and specific causes of death were determined using the National Death Index. The difference in all-cause and cardiac mortality between groups in the presence of competing risks was assessed using log-normal survival models. RESULTS: Out of 10,609 patients studied during the time period, 1,673 had a normal stress-only study and 3,237 had a normal rest-stress study. At one year, there were 20 total and 3 cardiac deaths (1.2% and 0.2% mortality) in the stress-only group, and 40 total and 4 cardiac deaths (1.2% and 0.1% mortality) in the rest-stress cohort. At the end of follow-up (40 +/- 9 months), there were 46 total and 7 cardiac deaths (2.7% and 0.4% mortality) in the stress-only group, and 119 total and 17 cardiac deaths (3.7% and 0.5% mortality) in the rest-stress cohort. No significant difference between the stress-only and rest-stress cohorts was found after controlling for confounding variables for both all-cause mortality (p = .94) and cardiac mortality (p = .82). CONCLUSIONS: A normal stress-only MPI has an excellent short-term prognosis (both for all-cause and cardiac mortality) comparable to that of a normal rest-stress MPI study.
Authors:
W Lane Duvall; Melanie N Wijetunga; Thomas M Klein; Louai Razzouk; Jim Godbold; Lori B Croft; Milena J Henzlova
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Publication Detail:
Type:  Journal Article    
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 Jun 
Date Detail:
Created Date:  2010-05-13     Completed Date:  2010-08-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  370-7     Citation Subset:  IM    
Affiliation:
Mount Sinai Department of Cardiology Mount Sinai Heart, Mount Sinai Medical Center, Box 1030, One Gustave L Levy Place, New York, NY 10029, USA. william.duvall@msnyuhealth.org
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MeSH Terms
Descriptor/Qualifier:
Coronary Disease / mortality,  radionuclide imaging
Dipyridamole / pharmacology
Dopamine / pharmacology
Exercise Test*
Female
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Myocardial Perfusion Imaging*
Prognosis
Radiopharmaceuticals / diagnostic use*
Risk Factors
Technetium / diagnostic use*
Tomography, Emission-Computed, Single-Photon
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 58-32-2/Dipyridamole; 7440-26-8/Technetium
Comments/Corrections
Comment In:
J Nucl Cardiol. 2010 Jun;17(3):347-9   [PMID:  20411382 ]

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


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