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Frequency of abnormal stress SPECT-MPI studies decreased in past two decades
New data reveal a progressive decrease in the frequency and severity of abnormal stress-rest single-photon emission CT–myocardial perfusion imaging studies during the past two decades.
Researchers studied 39,515 patients who underwent stress-rest myocardial perfusion imaging (MPI) between 1991 and 2009. They assessed demographic changes, clinical symptoms, risk factors, and frequency of abnormal and ischemic stress-rest SPECT-MPI over time.
The prevalence of abnormal SPECT studies declined from 40.9% in 1991 to 8.7% in 2009 (P<.001). In addition, the prevalence of ischemic SPECT-MPI decreased from 29.6% in 1991 to 5% (P<.001). A similar decline was also observed for the frequency of moderate to severely abnormal and ischemic studies.
The decrease in SPECT-MPI abnormality occurred in all age and symptom subgroups, and decreased to 2.9% among recent exercising patients without typical angina.
The researchers described a progressive trend toward the use of more pharmacological stress testing in all age and weight groups. Compared with exercise stress tests, pharmacological stress tests were more likely to be associated with SPECT-MPI abnormality (OR=1.43; 95% CI, 1.3-1.5).
“Two broad implications emanate from our findings. First, the declining frequency and severity of myocardial ischemia that was noted in our study may be reflecting a broader temporal change toward milder clinical presentations of CAD. …Second, the declining frequency of inducible myocardial ischemia, particularly among exercising patients without typical angina, suggests a need to refine the future diagnostic workup of patients with suspected CAD,” Alan Rozanski, MD, of the division of cardiology and department of medicine, St. Luke’s-Roosevelt Hospital, New York, and colleagues wrote.
Disclosure: The researchers report no relevant financial disclosures.