Different Clinical Profile of Patients Undergoing Coronary Arteriography after Stress SPECT or Stress Echocardiography

Purpose: Stress SPECT and stress echocardiography show similar diagnostic accuracy in patients with known or suspected coronary artery disease. The choice of which imaging modality is the most suitable may depend on several factors, including local facilities and expertise, cost containment, biological risk related to the use of radiations, and the feasibility of stress echocardiography. We hypothesized that some of the above factors could shape the characteristics of patients undergoing one or the other imaging modality. Thus, we sought to investigate whether patients referred to coronary arteriography after stress SPECT or stress echocardiography differ in terms of clinical and risk profile. Methods: We retrospectively analysed 1712 patients who had undergone stress SPECT (821 patients, 48%) or stress echocardiography (891 patients, 52%), followed by coronary arteriography (median, three days). Results: Patients studied by stress SPECT did not differ from stress echo patients as to age and extent of coronary stenoses, but were less frequently female (P=0.0021), more frequently had severe obesity (P= 0.0102), a previous myocardial infarction (P=0.0009), or severe left ventricular dysfunction (P<0.0001). During follow-up (median, 7 years), stress SPECT patients had a worst survival rate free from cardiac death and non-fatal infarction (81.4%) than stress-echo patients (85.6%, P=0.015). Conclusion: In our centre, stress SPECT is more commonly performed in higher risk patients than stress echocardiography.