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.
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.
Authors: Christopher L Hansen; Richard A Goldstein; Olakunle O Akinboboye; Daniel S Berman; Elias H Botvinick; Keith B Churchwell; C David Cooke; James R Corbett; S James Cullom; Seth T Dahlberg; Regina S Druz; Edward P Ficaro; James R Galt; Ravi K Garg; Guido Germano; Gary V Heller; Milena J Henzlova; Mark C Hyun; Lynne L Johnson; April Mann; Benjamin D McCallister; Robert A Quaife; Terrence D Ruddy; Senthil N Sundaram; Raymond Taillefer; R Parker Ward; John J Mahmarian Journal: J Nucl Cardiol Date: 2007 Nov-Dec Impact factor: 5.952
Authors: Axel R Pries; Helmut Habazettl; Giuseppe Ambrosio; Peter Riis Hansen; Juan Carlos Kaski; Volker Schächinger; Harald Tillmanns; Giuseppe Vassalli; Isabella Tritto; Michael Weis; Cor de Wit; Raffaele Bugiardini Journal: Cardiovasc Res Date: 2008-05-29 Impact factor: 10.787
Authors: Elizabeth Klodas; Todd D Miller; Timothy F Christian; David O Hodge; Raymond J Gibbons Journal: J Nucl Cardiol Date: 2003 Jan-Feb Impact factor: 5.952