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ORIGINAL ARTICLE
Year : 2014  |  Volume : 55  |  Issue : 1  |  Page : 14-19

Cardiovascular outcomes of a positive nuclear stress test but negative coronary angiography in a multiethnic male predominant cohort


1 Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
2 Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana, USA
3 Department of Dermatology, Penn State Hershey College of Medicine, Hershey, Pennsylvania, USA
4 Department of Internal Medicine, Vanderbilt-Meharry Medical College, Nashville, Tennessee, USA

Correspondence Address:
Daniel Addison
Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, Faculty Center, 1709 Dryden Rd, Suite 500, One Baylor Plaza, Houston, TX - 77030
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0300-1652.128151

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Background: Patients presenting with chest pain and evidence of functional ischemia by myocardial perfusion imaging (MPI), but lacking commensurate angiographic disease pose a diagnostic and therapeutic dilemma. They are often dismissed as having 'false-positive MPI'. Moreover, a majority of the available long-term outcome data for it has been derived from homogenous female populations. In this study, we sought to evaluate the long-term outcomes of this presentation in a multiethnic male-predominant cohort. Materials and Methods: We retrospectively identified 47 patients who presented to our institution between 2002 and 2005 with chest pain and evidence of ischemia on MPI, but with no significant angiographic disease on subsequent cardiac catheterization (cases). The occurrence of adverse cardiovascular outcomes (chest pain, congestive heart failure, acute myocardial infarction and stroke) post-index coronary angiogram was tracked. Similar data was collected for 37 patients who also presented with chest pain, but normal MPI over the same period (controls). Overall average follow-up was over 22 months. Results: Fifty-three percent (26/47) of the cases had one or more of the adverse outcomes as compared with 22% (8/37) of controls (P < 0.01). Of these, 13 (50.0%) and 3 (37.5%) were males, respectively. Conclusions: Ischemia on MPI is predictive of long-term adverse cardiovascular outcomes despite normal ('false-negative') coronary angiography. This appears to be gender-neutral.


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