ArticleEuropean journal of nuclear medicine and molecular imaging2015
Prospective evaluation of a new protocol for the provisional use of perfusion imaging with exercise stress testing.
Article in European journal of nuclear medicine and molecular imaging, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Brazilian Guideline for Exercise Test in the Adult Population - 2024.Arquivos brasileiros de cardiologia · 2024Guideline
- Clinical judgement in chest pain: a case report.Journal of medical case reports · 2021Article
- Staged testing as a solution to the challenges of testing lower risk patients.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Article
- A high exercise workload of ≥ 10 METS predicts a low risk of significant ischemia and cardiac events in older adults.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Article
- Clinical effectiveness of an outpatient pathway for low-risk chest pain emergency department visits.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Article
- Low-dose stress-only myocardial perfusion imaging.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Article
- CZT camera: moving beyond classical CAD detection?European journal of nuclear medicine and molecular imaging · 2015Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposePrevious literature suggests that myocardial perfusion imaging (MPI) adds little to the prognosis of patients who exercise >10 metabolic equivalents (METs) during stress testing. With this in mind, we prospectively tested a provisional injection protocol in emergency department (ED) patients presenting for the evaluation of chest pain in which a patient would not receive an injection of radioisotope if adequate exercise was achieved without symptoms and a negative ECG response.
methodsAll patients who presented to the ED over a 5-year period who were referred for stress testing as part of their ED evaluation were included. Patients considered for a provisional protocol were: exercise stress, age <65 years, no known coronary artery disease, and an interpretable rest ECG. Criteria for not injecting included a maximal predicted heart rate ≥85%, ≥10 METs of exercise, no anginal symptoms during stress, and no ECG changes. Groups were compared based on stress test results, all-cause and cardiac mortality, follow-up cardiac testing, subsequent revascularization, and cost.
resultsA total of 965 patients were eligible with 192 undergoing exercise-only and 773 having perfusion imaging. After 41.6 ± 19.6 months of follow-up, all-cause mortality was similar in the exercise-only versus the exercise plus imaging group (2.6% vs. 2.1%, p = 0.59). There were no cardiac deaths in the exercise-only group. At 1 year there was no difference in the number of repeat functional stress tests (1.6% vs. 2.1%, p = 0.43), fewer angiograms (0% vs. 4.0%, p = 0.002), and a significantly lower cost ($65 ± $332 vs $506 ± $1,991, p = 0.002; values are in US dollars) in the exercise-only group. The radiation exposure in the exercise plus imaging group was 8.4 ± 2.1 mSv.
conclusionsA provisional injection protocol has a very low mortality, few follow-up diagnostic tests, and lower cost compared to standard imaging protocols. If adopted it would decrease radiation exposure, save time and decrease health-care costs without jeopardizing prognosis.
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