Value of Stress Myocardial Perfusion Single Photon Emission Computed Tomography in Patients With Normal Resting Electrocardiograms

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Abstract
Background— The incremental value and cost-effectiveness of stress single photon emission computed tomography (SPECT) is of unclear added value over clinical and exercise treadmill testing data in patients with normal resting ECGs, a patient subset known to be at relatively lower risk. Methods and Results— We identified 3058 consecutive patients who underwent exercise dual isotope SPECT, who on follow-up (mean, 1.6±0.5 years; 3.6% lost to follow-up) were found to have 70 hard events (2.3% hard-event rate). Survival analysis used a Cox proportional hazards model, and cost-effectiveness was determined by the cost per hard event identified by strategies with versus without the use of SPECT. In this cohort, a normal study was associated with an exceedingly low hard-event rate (0.4% per year) that increased significantly as a function of the SPECT result. After adjusting for pre-SPECT information, exercise stress SPECT yielded incremental value for the prediction of hard events (χ2 52 to 85, P<0.001) and signi...

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