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Assessing Clinical Impact of Myocardial Perfusion Studies: Ischemia or Other Prognostic Indicators?

  • Nuclear Cardiology (V Dilsizian, Section Editor)
  • Published:
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Abstract

One of the major strengths of nuclear myocardial perfusion imaging (MPI) is the robust prognostic databases from observational studies demonstrating significantly different outcomes in patients with low-risk vs high-risk scans. The severity of the MPI defect can be semi-quantitated using the summed stress score (SSS) and summed difference score (SDS). SSS is more strongly associated with mortality, whereas SDS is the better predictor of subsequent coronary angiography and revascularization. The strength of MPI variables as prognostic indicators decreases when adjusted for prognostically important clinical and stress test variables. Nonetheless, most studies of general patient populations have demonstrated that MPI adds incremental prognostic value to clinical and stress test information. In contrast to these positive results from observational studies, the application of MPI ischemia as a treatment guide in several recent trials (DIAD, WOMEN, COURAGE, BARI 2D, STICH) has largely failed to identify patient subsets with improved outcome. This issue will continue to be investigated in the ongoing PROMISE and ISCHEMIA trials.

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Todd D. Miller has been a consultant for Astellas Pharma. John Wells Askew has worked for UpToDate. Joerg Herrmann declares that he has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Division of Cardiovascular Diseases and the Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Todd D. Miller, John Wells Askew & Joerg Herrmann

  2. Mayo Clinic, Gonda 6, 200 First Street SW, Rochester, MN, 55905, USA

    Todd D. Miller

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Correspondence to Todd D. Miller.

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Miller, T.D., Askew, J.W. & Herrmann, J. Assessing Clinical Impact of Myocardial Perfusion Studies: Ischemia or Other Prognostic Indicators?. Curr Cardiol Rep 16, 465 (2014). https://doi.org/10.1007/s11886-014-0465-8

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