Assessing Clinical Impact of Myocardial Perfusion Studies: Ischemia or Other Prognostic Indicators?

One of the major strengths of nuclear myocardial perfusion imaging (MPI) is the robust prognostic databases from observational studies demonstrating significantly different outcomes in patients with low-risk vs high-risk scans. The severity of the MPI defect can be semi-quantitated using the summed...

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Bibliographic Details
Published in:Current cardiology reports 2014-04, Vol.16 (4), p.465-465, Article 465
Main Authors: Miller, Todd D., Askew, John Wells, Herrmann, Joerg
Format: Article
Language:English
Subjects:
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Cardiology
Coronary Angiography
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - mortality
Coronary Artery Disease - physiopathology
Exercise Test - methods
Female
Humans
Image Processing, Computer-Assisted
Male
Medicine
Medicine & Public Health
Myocardial Ischemia - diagnostic imaging
Myocardial Ischemia - mortality
Myocardial Ischemia - physiopathology
Myocardial Perfusion Imaging
Nuclear Cardiology (V Dilsizian
Practice Guidelines as Topic
Prognosis
Radiopharmaceuticals
Risk Factors
Section Editor
Sensitivity and Specificity
Severity of Illness Index
Time Factors
Tomography, Emission-Computed, Single-Photon
Topical Collection on Nuclear Cardiology
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Summary:One of the major strengths of nuclear myocardial perfusion imaging (MPI) is the robust prognostic databases from observational studies demonstrating significantly different outcomes in patients with low-risk vs high-risk scans. The severity of the MPI defect can be semi-quantitated using the summed stress score (SSS) and summed difference score (SDS). SSS is more strongly associated with mortality, whereas SDS is the better predictor of subsequent coronary angiography and revascularization. The strength of MPI variables as prognostic indicators decreases when adjusted for prognostically important clinical and stress test variables. Nonetheless, most studies of general patient populations have demonstrated that MPI adds incremental prognostic value to clinical and stress test information. In contrast to these positive results from observational studies, the application of MPI ischemia as a treatment guide in several recent trials (DIAD, WOMEN, COURAGE, BARI 2D, STICH) has largely failed to identify patient subsets with improved outcome. This issue will continue to be investigated in the ongoing PROMISE and ISCHEMIA trials.
ISSN:1523-3782
1534-3170
DOI:10.1007/s11886-014-0465-8