Pharmacologic Cardiac Stress (PS-SPECT): Still Valuable for Prognosis in Chronic Coronary Syndrome

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Objective: Pharmacologic cardiac stress SPECT (PS-SPECT) has been commonly used test for non-invasive evaluation of ischaemic heart disease (IHD) in patients unable to exercise. New techniques (like cardiac CT-scan) are replacing its use in many clinical scenarios and scientific publications. However, it is still the only available test for non-invasive evaluation of some patients in many hospitals. The aim of the study was to evaluate the prognostic value of PS-SPECT currently.

Materials and methods: Retrospective study of 1,214 patients referred for PS-SPECT between 2010 and 2016 who completed a median follow-up of 3 years. Patients had a median age of 74 ±1 0 years, 56% were women, and had high prevalence of cardiovascular risk factors – diabetes (51%); arterial hypertension (86%); hypercholesterolaemia (60%); chronic IHD (38%) or peripheral artery disease (44%). Dipyridamole was the drug used for stress in 89% of cases.

Results: 41% of the patients presented moderate or severe ischemia (MS-ISC) whereas 46% of patients had normal perfusion (NP). Global mortality was high at 1 year (5.5%) and at long-term follow-up (26.5%), and was significantly lower (p<0.001) for patients with NP both at first year (3%) and at the end of follow-up (19.6%). Patients with MS-ISC had highest mortality at 1 year (8.6%, p=0.065) and at long-term follow-up (42.6%, p<0.001).

Conclusion: PS-SPECT is still a valuable prognostic tool for patients with suspected IHD unable to exercise. Even in high-risk populations, the presence of MS-ISC and NP identifies those patients with the highest and lowest mortality risk, respectively.