Role of myocardial perfusion imaging in risk stratification

This review paper is based on a topic invited for review presented by the first author at the Annual Meeting of Society of Nuclear Medicine of Serbia and Montenegro, September 2003. The optimal management of patients affected by coronary artery disease requires safe and cost-effective techniques for assessing the risk of subsequent cardiac events or the need for surgery. The ideal test should distinguish between high risk patients who will benefit from aggressive management and low risk patients who can be managed conservatively. Stress testing alone is believed to be inadequate for the assessment of risk. Nuclear Medicine techniques have routinely been used in the identification of patients with ischaemic heart disease and those with viable myocardium post myocardial infarction. While the essential methodology for the techniques remains same, the reporting and interpretation criteria for determining future risk are different. For instance, a fixed perfusion defect on stress myocardial perfusion imaging in a patient presenting cardiactype chest pain to the cardiologists for the first time, has a different value from a similar patient being presented to the noncardiologist for major vascular surgery. A review of the literature concerning the current usage of nuclear cardiology techniques in risk stratification is presented.