A model for the prediction of a successful stress-first Tc-99m SPECT MPI

Abstract

This pre-test scoring tool accurately identifies patients who can successfully undergo a stress-first imaging protocol without the need for rest imaging and may allow for wider adoption of stress-first imaging protocols.

Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation

“…176,177 Despite lack of consensus, one large study enrolling more than 16,000 patients implied that a stress-first study is appropriate in most patients except for those who have known prior myocardial infarction or in those where a two-day protocol is not practical. 37 In this study by Chang et al, 89% of patients had either a history of CAD (31%) or at least an intermediate risk for CAD (58%).…”

Radiation Dose and Prognosis of Ultra-Low-Dose Stress-First Myocardial Perfusion SPECT in Patients with Chest Pain Using a High-Efficiency Camera

“…Recent work by Duvall et al (18) has developed a scoring system to predict "unsuccessful" stress-first imaging that requires subsequent rest imaging. Use of this scoring system in conjunction with ULD HE-SPECT imaging may be helpful in developing protocols to further streamline emergency department flow; this hypothesis requires further validation in a cohort receiving ultra-low doses.…”

Choosing patients for stress-first/stress-only imaging: Keep it simple

“…6 This model performed well in their derivation and validation groups, identifying patients at low, intermediate, and high risk for unsuccessful (abnormal) stress-first imaging. However, as the authors point out, this model is somewhat complex and not easily and quickly applied by those who would be scheduling (if adjustments in lab scheduling need to be made for such patients) or initiating the stress test.…”

“…[3][4][5][6] However, one issue with attempting to perform stress-only imaging is choosing good candidates for such a protocol. Although the vast majority of stress myocardial perfusion imaging (MPI) studies performed today are normal, 7,8 there are still patients for whom it might be predicted that such a protocol is not ideal, such as those who have had a prior abnormal study or prior myocardial infarction.…”