10 Real-world evidence of the safety of pharmacologic stress in myocardial perfusion imaging

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Abstract

Introduction

Myocardial perfusion imaging (MPI) is increasingly used as recommended by NICE for patients with a 30–60% estimated likelihood of coronary artery disease. We aimed to investigate the safety of drugs used in patients undergoing pharmacologic stress MPI.

Methods

A 9-month (May 2015–Feb 2016) retrospective study to investigate the incidence of adverse effects (AE) in patients undergoing pharmacologic stress MPI. We employ standardised protocols (Tc-99m) using 4 agents: dipyridamole, regadenoson, adenosine and dobutamine. Clinical data including AEs were collected from cardiobase. Descriptive analysis and frequencies were calculated. AE in MPI were compared to those occurring in 50 patients who underwent conventional exercise tolerance testing (ETT) using chi-squared test.

Findings

Of the 360 patients (mean age 67 years [SD 11]; 196 men, 164 women), who had pharmacologic stress agent administered, 166 (46%) became symptomatic: dyspnoea (24.7%), chest discomfort (12.8%), flushing (10%), chest pain (3.6%), cough (3.3%), nausea (2.8%), pain elsewhere (2.5%), dizziness (2.5%), vasovagal reaction (2.2%), wheeze (1.9%), headache (1.9%), vomiting (0.8%), abdominal discomfort (0.8%). The commonest symptom was chest discomfort for dobutamine but dyspnoea for all the other agents. Adenosine had the highest incidence of AE (76%). No significant complications were recorded that required hospital admission. When compared with ETT there was no significant difference of adverse effects (MPI 166/360 [44%], ETT 29/50 [58%]; p=0.12).

Conclusions

This real-world data show that pharmacologic stress MPI is safe when clinical protocols are followed. Technician (physicist)-led testing could be an alternative in busy cardiac units where medical staffing are not always available.

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