Lars Edenbrandt, Mattias Ohlsson and Elin Trädgårdh
Prognosis of patients without perfusion defects with and without rest study in myocardial perfusion scintigraphy
LU TP 13-19

Background: Stress myocardial perfusion scintigraphy (MPS) is widely regarded as a useful imaging modality for diagnosing patients with suspected ischemic heart disease. Current European guidelines recommend the stress study to be performed first, since the rest study can be omitted if the stress study is interpreted as normal. Thus a rest study should only be performed in patients with equivocal or abnormal studies. The aim of the present study was to investigate the prognosis of a normal stress-only MPS compared to a normal stress-rest MPS in a retrospective manner, and also with regard to normal/abnormal LV function data.

Methods: All 4820 patients who underwent Tc-99m MPS at Skåne University Hospital in Malmö, Sweden, in 2004-2007, for suspected or management of known ischemic heart disease were considered. The physician in clinical charge of the investigation decided whether a rest study was necessary or not. Based on the final report according to clinical routine, only patients with a normal perfusion study (no infarction or inducible ischemia) were included. The endpoints were non-fatal acute coronary syndrome or death from ischemic cardiac origin.

Results: A total of 3426 patients with a normal perfusion study were included. Of these, 2215 patients had a stress-only study and 1211 patients had both stress and rest studies. Mean follow-up was 6.2 years. The lowest event rate was found in the normal stress-only group (0.56% for normal stress-only patients vs. 1.42% for normal stress-rest patients; p<0.0001). When dividing patients according to sex and stress type, the best prognosis was also found in the normal stress-only group (p<0.0001 for all comparisons). When regarding left ventricular function data, we did not find any significant difference in event rate between normal vs abnormal ejection fraction (EF), normal vs. abnormal end-diastolic volume (EDV) or normal EF and EDV vs. abnormal EF or EDV for either the normal stress-only patients or the normal stress-rest patients.

Conclusions: Patients with a normal stress-only study had an excellent prognosis over a mean follow-up time of 6 years. Thus, omitting the rest study if the stress study is normal is a safe procedure.

LU TP 13-19