Abstract
Background:
Coronary atherosclerosis is a dynamic disease with sudden and unpredictable bouts of progression. According to the most recent appropriateness use criteria (AUC), repeat testing within 2-years of a normal MPI is rarely appropriate for asymptomatic patients or in those with stable symptoms. Nonetheless, numerous patients with or without symptoms undergo repeat testing. Predictors of reversible ischemia on MPI within 2-years of a normal study has not been evaluated.
Methods:
After IRB approval, records from veterans who underwent multiple MPI stress testing within 2-years of a negative MPI, between 2013 and 2016, at our VA Medical Center were accessed and variables of interest collected. A multivariate logistic regression analysis was performed to determine predictors of reversible ischemia on repeat MPI.
Results:
We identified a total of 239 veterans with repeat stress MPI within 2-years of a prior negative MPI. The median age was 65, with 35% (83 of 239) having a history of clinical ASCVD. The median interval between tests was 14 months [IQR, 10 to 18]. Nearly 17% (41 of 239) of repeat tests were positive. Multivariate regression analysis failed to find an association between reversible ischemia on repeat MPI and our variables of interest as displayed in Table 1.
Conclusion:
Our study was unable to find a relationship between any traditional risk factors for ASCVD, including new symptoms, and the development of reversible perfusion defects on MPI within 2-years of a normal study. Further studies are needed to help identify those patients who would most benefit from a repeat MPI.