Mortality risk among patients undergoing exercise versus pharmacologic myocardial perfusion imaging: A propensity-based
- PDF / 1,016,874 Bytes
- 13 Pages / 593.972 x 792 pts Page_size
- 61 Downloads / 159 Views
b c
The Department of Cardiology, Mount Sinai Morningside Hospital and Mount Sinai Heart, New York Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA
Received May 3, 2020; accepted Jun 22, 2020 doi:10.1007/s12350-020-02294-y
Background:. The increased risk associated with pharmacologic versus exercise testing is obscured by the higher prevalence of clinical risk factors among pharmacologic patients. Thus, we assessed comparative mortality in a large risk factor-matched group of exercise versus pharmacologic patients undergoing stress/rest SPECT myocardial perfusion imaging (MPI). Methods:. 39,179 patients undergoing stress/rest SPECT-MPI were followed for 13.3 ± 5.0 years for all-cause mortality (ACM). We applied propensity-matching to create pharmacologic and exercise groups with similar risk profiles. Results:. In comparison to exercise patients, pharmacologic patients had an increased riskadjusted hazard ratio for ACM for each level of ischemia: increased by 3.8-fold (95%CI 3.5-4.1) among nonischemic patients, 2.5-fold (95%CI 2.0-3.2) among mildly ischemic patients, and 2.6fold (95%CI 2.1-3.3) among moderate/severe ischemic patients. Similar findings were observed among a propensity-matched cohort of 10,113 exercise and 10,113 pharmacologic patients as well as in an additional cohort that also excluded patients with noncardiac co-morbidities. Conclusions. Patients requiring pharmacologic stress testing manifest substantially heightened clinical risk at each level of myocardial ischemia and even when myocardial ischemia is absent. These findings suggest the need to study the pathophysiological drivers of increased risk in association with pharmacologic testing and to convey this risk in clinical reports. (J Nucl Cardiol 2020) Key Words: Coronary artery disease Æ Myocardial ischemia Æ Stress testing Æ Myocardial perfusion imaging
The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02294-y) contains supplementary material, which is available to authorized users.
Reprint requests: Alan Rozanski, MD, The Department of Cardiology, Mount Sinai Morningside Hospital and Mount Sinai Heart, 1111 Amsterdam Avenue, New York10025; [email protected] 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
Rozanski et al Exercise versus Pharmacologic Testing
Abbreviations SPECT Stress–rest single-photon emission computed tomography MPI Myocardial perfusion imaging CAD Coronary artery disease CSMC Cedars-Sinai Medical Center LV Left ventricular LVEF Left ventricular ejection fraction
Journal of Nuclear CardiologyÒ
were lost to minimum 5 years of follow-up. Among the remaining 39,179 patients, the me
Data Loading...
