Background: Myocardial perfusion imaging (MPI) is commonly used to assess the presence and severity of coronary artery disease (CAD). A radiopharmaceutical is used before and after patients undergo either exercise-induced stress via a treadmill or medication-induced stress. While certain therapies that are known to influence the accuracy of results are avoided prior to conducting MPI, it is currently unknown whether nicotine and nicotine replacement therapy (NRT) should be avoided, even though they may have significant effects on coronary circulation. Observations: Nicotine has been demonstrated to have both vasoconstrictive and vasodilatory properties. However, in patients with underlying CAD, vasoconstrictive properties ap-pear to predominate and can allow the disease to appear more severe than it is during MPI. Similarly, NRT products may cause vasoconstriction but to a lesser degree given the lower concentration of nicotine present. Due to the lack of robust studies, the clinical impact of these findings on clinician diagnosis and patient management remains unclear. Conclusions: Based on the available data, nicotine and NRT should ideally be avoided prior to MPI. The specific time frame in which they would be stopped before conducting MPI differs based on the pharmacokinetics of each product. More studies are needed to analyze the impact of nicotine and NRT on the accuracy of MPI using medication.

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