Author + information
- Received August 12, 2009
- Revision received September 22, 2009
- Accepted September 28, 2009
- Published online January 19, 2010.
- Su Min Chang, MD*,
- Faisal Nabi, MD*,
- Jiaqiong Xu, PhD†,
- Umara Raza, MD* and
- John J. Mahmarian, MD*,* ()
- ↵*Reprint requests and correspondence:
Dr. John J. Mahmarian, Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Suite 677, Houston, Texas 77030
Objectives The aim of this study was to determine whether a normal stress-only single-photon emission computed tomographic myocardial perfusion tomography (SPECT) study confers the same prognosis as a normal SPECT on the basis of evaluation of stress and rest images.
Background Current guidelines recommend stress and rest imaging to confirm that a SPECT study is normal.
Methods We determined all-cause mortality in 16,854 consecutive patients who had a normal gated stress SPECT. Median follow-up was 4.5 years. A stress-only protocol was used in 8,034 patients (47.6%), whereas 8,820 (52.4%) had both stress and rest imaging.
Results The overall unadjusted annual mortality rate in patients who had a normal SPECT with a stress-only protocol was lower than in those who required additional rest imaging (2.57% vs. 2.92%, p = 0.02). After adjustment for baseline clinical characteristics no significant differences in patient mortality were seen between the 2 imaging protocols, but the stress-only group received a 61% lower radiopharmaceutical dosage. Independent predictors of worse survival included increasing age, male sex, diabetes, history of coronary artery disease, and inability to exercise (all p < 0.001) but not the type of SPECT protocol used to image patients.
Conclusions Patients determined to have a normal SPECT on the basis of stress imaging alone have a similar mortality rate as those who have a normal SPECT on the basis of evaluation of both stress and rest images. Our results support that additional rest imaging is not required in patients who have a normally appearing initial stress study. A significant reduction in radiation exposure can be achieved with such an approach.
- Received August 12, 2009.
- Revision received September 22, 2009.
- Accepted September 28, 2009.
- American College of Cardiology Foundation