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Additional rest imaging not required in patients with normal-appearing SPECT stress imaging
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Patients who had a normal SPECT based on stress imaging alone had a similar low mortality rate as patients who underwent stress and rest imaging in a new study.
“Our findings support that patients who have a normal-appearing initial stress SPECT do not require additional rest imaging,” the researchers wrote. “This imaging strategy will significantly reduce radiation exposure in a substantial number of patients,” the researchers wrote.
Researchers evaluated all-cause mortality in 16,854 consecutive patients who had a normal gated stress SPECT (stress only protocol, 47.6%; stress and imaging, 52.4%).
After 4.5 years of follow-up, the overall unadjusted annual mortality rate was lower in patients who had a normal SPECT with a stress only protocol vs. patients who required both stress and rest imaging (2.57% vs. 2.92%; P=.02). The researchers reported no significant differences in mortality between the two protocols after adjustment for baseline clinical characteristics. However, the stress-only protocol group had a 61% lower radiopharmaceutical dosage.
Increasing age, male sex, diabetes, history of coronary artery disease and inability to exercise independently predicted worse survival (P<.001 for all). Type of SPECT protocol was not an independent predictor.
Chang SM. J Am Coll Cardiol. 2010;55:221-230.