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CLINICAL STUDY: STRESS TESTING

Low event rate for stress-only perfusion imaging in patients evaluated for chest pain

^* Rhode Island Hospital and Brown University, Providence, Rhode Island, USA

Manuscript received July 23, 2001; revised manuscript received December 18, 2001, accepted December 19, 2001.

^* Reprint requests and correspondence: Dr. Lynne L. Johnson, Rhode Island Hospital, Main Building, Room 208, 593 Eddy Street, Providence, Rhode Island 02903, USA.
Lynne_Johnson{at}brown.edu

OBJECTIVES: We sought to demonstrate the safety of stress-only perfusion imaging among patients with low to medium probability of coronary disease being evaluated for chest pain.

BACKGROUND: The need for performing rest in addition to stress perfusion imaging to confirm normalcy is due largely to defects created on the stress images by attenuation artifacts. A low cardiac event rate among patients undergoing stress-only imaging with attenuation correction (AC) would validate the safety of stress-only imaging.

METHODS: Patients with low to medium pretest probability for coronary artery disease (CAD) referred for chest pain evaluation from July 1, 1997 to July 1, 1999, were scheduled for a two-day stress/rest tomographic (single photon emission computerized tomography, or SPECT) perfusion imaging study with Tc-99m sestamibi. Patients were imaged on a variable angle camera with AC using Gd-153 scanning line sources (Vantage ADAC, Milpitas, California). If the stress scan was normal without AC or corrected with AC, the patient did not return for rest scan and was followed.

RESULTS: Seven hundred twenty-nine patients underwent stress-only imaging, and follow-up was obtained on 652 (89%) of those patients. There were 224 males and 428 females with mean age of 52 ± 13 years. Mean follow-up was 22.3 ± 6.4 months. The mean pretest probability was 37 ± 24%. The non-AC images showed breast and/or diaphragmatic attenuation artifacts severe enough to have required the patient to return for rest imaging in 37% of patients, and all corrected completely with AC. During follow-up, there were two noncardiac deaths and no cardiac deaths. There was one myocardial infarction; three patients with progressive unstable angina underwent diagnostic coronary angiography showing significant CAD. The overall cardiac event rate was 0.6%.

CONCLUSIONS: These results support stress-only imaging in patients with low to medium probability for CAD as a safe, time- and cost-efficient imaging modality.

Abbreviations and Acronyms   SPECT   AC   attenuation correction   CAD   coronary artery disease   ECG   electrocardiogram   LV   left ventricular   RCA   right coronary artery   SPECT   single photon emission computerized tomography

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