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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

Adenosine-induced ST segment depression with normal perfusion

Fadi G Hage1, Jaekyeong Heo, Ami E Iskandrian

  • 1Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. fadihage@uab.edu

Cardiology Journal
|April 24, 2009
PubMed

Insights

Patients with an ischemic electrocardiogram (ECG) response to adenosine but normal myocardial perfusion imaging have a low risk of cardiac events. This suggests non-ischemic mechanisms for the ECG changes, indicating a benign long-term outcome.

Area of Science:

  • Cardiology
  • Nuclear Cardiology
  • Diagnostic Imaging

Background:

  • Intravenous adenosine stress testing with myocardial perfusion imaging is standard for diagnosing coronary artery disease.
  • Previous studies indicated a favorable short-term prognosis for patients with ischemic ECG responses but normal perfusion.
  • The long-term outcomes for this specific patient group remained undetermined.

Purpose of the Study:

  • To evaluate the long-term outcomes of patients exhibiting an ischemic electrocardiogram (ECG) response to adenosine stress testing despite normal myocardial perfusion imaging.
  • To assess the risk of mortality, myocardial infarction, and coronary revascularization in this cohort.

Main Methods:

  • A cohort of 73 patients with ischemic ECG responses (≥1 mm ST depression) to adenosine infusion and normal single-photon emission computed tomography (SPECT) perfusion were retrospectively analyzed.
  • Patients with prior myocardial infarction or coronary revascularization were excluded.
  • Follow-up data for mortality, myocardial infarctions, and coronary revascularization were collected.

Main Results:

  • The study followed 73 patients (81% women) for a mean of 61 months.
  • Ten deaths occurred, with half attributed to non-cardiac causes.
  • During a mean follow-up of 21 months for other endpoints, no myocardial infarctions were recorded, and seven patients underwent coronary revascularization.

Conclusions:

  • Patients with an ischemic ECG response to adenosine and normal SPECT perfusion have a low risk of major adverse cardiovascular events.
  • The observed ST segment changes in this context are likely due to non-ischemic mechanisms.
  • This finding supports a benign long-term prognosis for this patient subgroup.
Abstract

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