Temporal trends in the frequency of inducible myocardial ischemia during cardiac stress testing: 1991 to 2009

Alan Rozanski, Heidi Gransar, Sean W. Hayes, James Min, John D. Friedman, Louise E.J. Thomson, Daniel S. Berman

Research output: Contribution to journalArticlepeer-review

301 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1054-1065
Number of pages12
JournalJournal of the American College of Cardiology
Volume61
Issue number10
DOIs
StatePublished - 2013
Externally publishedYes

Keywords

  • coronary artery disease risk factors
  • myocardial ischemia
  • perfusion
  • prognosis

Fingerprint

Dive into the research topics of 'Temporal trends in the frequency of inducible myocardial ischemia during cardiac stress testing: 1991 to 2009'. Together they form a unique fingerprint.

Cite this