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Can the cold pressor test predict future cardiovascular events in patients without demonstrated ischemic heart
Enrique Pautasso1, Martin Koretzky1, Leopoldo Marcon2
1Centro de Cardiologia Nuclear, Buenos Aires, Argentina.
Insights
A positive cold pressor test (CPT) identifies patients at high risk for cardiovascular events, even after a normal myocardial perfusion scintigraphy (MPS). This simple test aids in stratifying risk for symptomatic coronary artery disease (CAD).
Area of Science:
- Cardiology
- Diagnostic Testing
- Risk Stratification
Background:
- Coronary artery disease (CAD) risk assessment is crucial, especially in patients with risk factors but no known disease.
- Myocardial perfusion scintigraphy (MPS) is a standard diagnostic tool, but identifying high-risk individuals with normal MPS results remains challenging.
Purpose of the Study:
- To determine if the cold pressor test (CPT) can identify patients at high risk for cardiovascular events.
- To assess the utility of CPT in patients with normal myocardial perfusion scintigraphy (MPS) results and no known coronary artery disease (CAD).
Main Methods:
- A cohort of 870 patients with CAD risk factors, referred for MPS, underwent CPT between day 3 and day 5 post-MPS.
- Patients were followed for a mean of 40 months to track cardiac death, non-fatal myocardial infarction, and revascularization procedures.
Main Results:
- A positive CPT was observed in 38.2% of patients.
- Patients with a positive CPT had a fourfold increased risk of cardiovascular events compared to those with a negative CPT (90.4% vs. 98.1% event-free survival).
- Diabetic patients with a positive CPT faced a 4.5 times higher risk of cardiovascular events.
Conclusions:
- A positive CPT can identify a subgroup of patients with a normal MPS who are at higher risk of developing symptomatic CAD.
- The findings suggest that a CPT should be considered in patients with a normal post-exercise MPS to further refine cardiovascular risk assessment.
Objective:
To assess whether a cold pressor test (CPT) could help identify patients at a high risk of cardiovascular events in a population without known coronary artery disease (CAD) with a normal myocardial perfusion scintigraphy (MPS).
Methods:
Our population consisted of 870 patients with a mean age of 59.3years with several CAD risk factors, having been referred for an MPS. The CPT was performed between the third day and fifth day after the MPS.
Results:
The CPT was positive in 38.2% of the patients. After a mean 40-month follow-up, the patients were contacted to check for cardiac death, non-fatal myocardial infarction, and myocardial revascularization procedures. The event-free survival rates were 98.1% and 90.4% after a negative or positive CPT, respectively (p=0.0001). The positive CPT group exhibited a fourfold increased risk of CV events. All CV events in the negative CPT group occurred after a 30-month follow-up. The risk of CV events was 4.5 times higher in diabetic patients.
Conclusion:
A positive CPT in patients with a negative MPS could help identify a subgroup of patients at a higher risk of developing symptomatic CAD.
Practice Implications:
Our results suggest that after a normal post-exercise MPS, patients should undergo a CPT.
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