Nuclear stress tests provide significant value when treating CAD
For some patients with myocardial ischemia—obstructed blood flow to the heart—it can be difficult for physicians to decide whether coronary revascularization through bypass surgery or angioplasty is the best treatment option. Now, a new Mount Sinai study shows that nuclear stress tests may provide some much-needed context.[1]
The study, published in the Journal of the American College of Cardiology, focused on data from more than 43,000 patients who underwent stress-rest single-photon emission computed tomography myocardial perfusion imaging from 1998 to 2017. The median follow-up period was 11.4 years.
Overall, the authors found that patients who experienced mortality benefits from revascularization procedures were those who had severe myocardial ischemia when undergoing stress testing. Patients who had no or mild ischemia during stress testing, however, did not experience any significant mortality benefits from revascularization.
“These results confirm the benefits of stress testing for clinical management," Alan Rozanski, MD, professor of medicine at Mount Sinai’s Icahn School of Medicine and the director of nuclear cardiology and cardiac stress testing at Mount Sinai Morningside said in a statement. "What you want from any test when considering coronary revascularization procedures is that the test will identify a large percentage of patients who are at low clinical risk and do so correctly, while identifying only a small percentage of patients who are at high clinical risk and do so correctly. That is what we found with nuclear stress testing in this study."
Specifically, the study found that patients with severe ischemia during stress testing who underwent revascularization procedures had 30% higher survival rates than those who managed their condition through medication alone.
These higher survival rates were even consistent among patients with prior heart damage, as identified through low percentages of blood volume pumped out of the heart’s left ventricle during each heartbeat, also known as the left ventricular ejection fraction (LVEF). Patients with severe ischemia were also likely to have a low LVEF.
No matter their course of treatment, patients with stress-induced myocardial ischemia fared worse in terms of overall mortality risk than their counterparts with no or mild ischemia.
Related Stress Test Content:
AMA supports reimbursement for pharmacologic stress agent regadenoson
American Society of Nuclear Cardiology says AHA/ACC chest pain guidelines miss the mark
Mental stress associated with repeat heart attacks, death from heart disease
Reference:
1. Rozanski, A; Miller, R.J.H.; Gransar, H; et al. Benefit of Early Revascularization Based on Inducible Ischemia and Left Ventricular Ejection Fraction. Journal of the American College of Cardiology, July 2022.