Journal of Nuclear Cardiology

, Volume 17, Issue 3, pp 370–377

The prognosis of a normal stress-only Tc-99m myocardial perfusion imaging study

  • W. Lane Duvall
  • Melanie N. Wijetunga
  • Thomas M. Klein
  • Louai Razzouk
  • Jim Godbold
  • Lori B. Croft
  • Milena J. Henzlova
Original Article

Abstract

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.

Keywords

Myocardial perfusion imaging: SPECT diagnostic and prognostic application outcomes research 

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Copyright information

© American Society of Nuclear Cardiology 2010

Authors and Affiliations

  • W. Lane Duvall
    • 1
  • Melanie N. Wijetunga
    • 2
  • Thomas M. Klein
    • 2
  • Louai Razzouk
    • 2
  • Jim Godbold
    • 3
  • Lori B. Croft
    • 1
  • Milena J. Henzlova
    • 1
  1. 1.Mount Sinai Department of Cardiology (Mount Sinai Heart)Mount Sinai Medical CenterNew YorkUSA
  2. 2.Mount Sinai Department of MedicineMount Sinai Medical CenterNew YorkUSA
  3. 3.Mount Sinai Department of Community and Preventative MedicineMount Sinai Medical CenterNew YorkUSA

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