Clinical Research
Coronary Artery Disease
Temporal Trends in the Frequency of Inducible Myocardial Ischemia During Cardiac Stress Testing: 1991 to 2009

https://doi.org/10.1016/j.jacc.2012.11.056Get rights and content
Under an Elsevier user license
open archive

Objectives

This study sought to assess whether the frequency of inducible myocardial ischemia during stress-rest single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has changed over time.

Background

The prevalence of cardiac death and other clinical cardiac events have declined in recent decades, but heretofore no study has examined if there has been a temporal change in the frequency of inducible myocardial ischemia during cardiac stress testing.

Methods

We assessed 39,515 diagnostic patients undergoing stress-rest MPI between 1991 and 2009. Patients were assessed for change in demographics, clinical symptoms, risk factors, and frequency of abnormal and ischemic SPECT-MPI.

Results

There was a marked progressive decline in the prevalence of abnormal SPECT studies, from 40.9% in 1991 to 8.7% in 2009 (p < 0.001). Similarly, the prevalence of ischemic SPECT-MPI declined, from 29.6% to 5.0% (p < 0.001), as did the prevalence of severe ischemia. The decline of SPECT-MPI abnormality occurred among all age and symptom subgroups, falling to only 2.9% among recent exercising patients without typical angina. We also noted a progressive trend toward performing more pharmacological rather than exercise stress in all age and weight groups, and pharmacological stress was more likely than exercise to be associated with SPECT-MPI abnormality (odds ratio: 1.43, 95% confidence interval: 1.3 to 1.5; p < 0.001).

Conclusions

Over the past 2 decades, the frequency and severity of abnormal stress SPECT-MPI studies has progressively decreased. Notably, the frequency of abnormal SPECT-MPI is now very low among exercising patients without typical angina. These findings suggest the need for developing more cost-effective strategies for the initial work-up of patients who are presently at low risk for manifesting inducible myocardial ischemia during cardiac imaging procedures.

Key Words

coronary artery disease risk factors
myocardial ischemia
perfusion
prognosis

Abbreviations and Acronyms

CAC
coronary artery calcium
CAD
coronary artery disease
MPI
myocardial perfusion imaging
SPECT
single-photon emission computed tomography

Cited by (0)

Dr. Berman has reported having relationships with Lantheus Medical Imaging, Astellas Pharma US, Inc., GE Healthcare, Siemens, Cardium Therapeutics, Spectrum Dynamics, and Cedars-Sinai. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.