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Comparative Study
. 2010 Dec;17(6):999-1008.
doi: 10.1007/s12350-010-9300-9. Epub 2010 Nov 13.

Comparison of long-term mortality risk following normal exercise vs adenosine myocardial perfusion SPECT

Alan Rozanski  1 , Heidi Gransar, Sean W Hayes, John D Friedman, Rory Hachamovitch, Daniel S Berman
Affiliations
Comparative Study

Comparison of long-term mortality risk following normal exercise vs adenosine myocardial perfusion SPECT

Alan Rozanski et al. J Nucl Cardiol. 2010 Dec.

Abstract

Background: A higher frequency of clinical events has been observed in patients undergoing pharmacological vs exercise myocardial perfusion single-photon emission computed tomography (SPECT). While this difference is attributed to greater age and co-morbidities, it is not known whether these tests also differ in prognostic ability among patients with similar clinical profiles.

Methods and results: We assessed all-cause mortality rates in 6,069 patients, followed for 10.2 ± 1.7 years after undergoing exercise or adenosine SPECT. We employed propensity analysis to match exercise and adenosine subgroups by age, gender, symptoms, and coronary risk factors. Within our propensity-matched cohorts, adenosine patients had an annualized mortality rate event rates that was more than twice that of exercise patients (3.9% vs 1.6%, P < .0001). Differences in mortality persisted among age groups, including those <55 years old. In the exercise cohort, mortality was inversely related to exercise duration, with comparable mortality noted for patients exercising <3 min and those undergoing adenosine testing.

Conclusions: Among patients with normal stress SPECT tests, those undergoing adenosine testing manifest a mortality rate that is substantially higher than that observed among adequately exercising patients, but comparable to that observed among very poorly exercising patients. This elevated risk underscores an important challenge for managing patients undergoing pharmacological stress testing.

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Figures

Figure 1
Figure 1
Comparison of probability of survival from death (y-axis) during 10-year follow-up from all causes in patients undergoing exercise vs adenosine SPECT. (A) Comparison of all exercise and adenosine patients in our study prior to propensity matching. (B) The comparative survival in exercise and adenosine patients following propensity-matching based on age, gender, chest pain symptom, and CAD risk factors. ACM, All-cause mortality
Figure 2
Figure 2
Comparative survival of the propensity-matched exercise and adenosine patients following division of these patients by age
Figure 3
Figure 3
Comparison of survival in the propensity-matched exercise and adenosine patients, with the exercise patients divided according to exercise duration. Mortality rate increased progressively as exercise duration diminished. There was no statistical difference in mortality rate among patients unable to exercise >3 min and patients undergoing adenosine SPECT (P = .65)
See this image and copyright information in PMC

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References

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