Patients with adenosine-induced ST-segment depressions and normal myocardial perfusion imaging: Cardiac outcomes at 24 months

Jyoti Sharma, Christine Roncari, Kenneth N. Giedd, John T. Fox, Yumiko Kanei

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Background: The significance of ischemic ECG changes during adenosine infusion in patients with normal myocardial perfusion imaging (MPI) is controversial. We evaluated the prevalence of, and defined the predictors for, severe coronary artery disease (CAD) in patients with such discordant findings. Methods: The findings of 3700 adenosine MPI studies performed at our institution between June 2005 and March 2009 were reviewed. Results: Data for 76 patients who had not previously undergone coronary revascularization and who had sufficient follow-up were analyzed; 22 (29%) were referred for coronary angiography and 10 (13%) underwent revascularization. None had left main disease and only three (14%) had multivessel disease. Diabetes mellitus was more prevalent (70% vs. 23%; P = .010) and ischemic ST-segment depressions more often lasted >5 minutes (50% vs. 15%; P = 0.021) in patients undergoing revascularization. During a 24 ± 13 month follow-up period, there were no deaths or myocardial infarctions, while an eleventh patient underwent revascularization 19 months after MPI. Conclusions: In the presence of normal MPI, the specificity of ischemic ECG changes during adenosine infusion for the detection of severe obstructive CAD is poor, although patients with multiple coronary risk factors, particularly diabetes mellitus, should undergo further investigation.

Original languageEnglish
Pages (from-to)874-880
Number of pages7
JournalJournal of Nuclear Cardiology
Volume17
Issue number5
DOIs
StatePublished - Oct 2010
Externally publishedYes

Keywords

  • Pharmacologic stress
  • adenosine
  • coronary artery disease
  • myocardial perfusion imaging: SPECT

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