Yield and Diagnostic Value of Stress Myocardial Perfusion Imaging in Patients Without Known Coronary Artery Disease Presenting with Syncope AlJaroudi et al: Role of Stress MPI in Syncope

Background—ACC/AHA Appropriate Use Criteria recommend performing stress MPI for intermediate to high-risk patients presenting with syncope, but not for low-risk patients. However, there are limited data to support these recommendations. We investigated the yield of stress MPI for the evaluation of syncope in patients at risk but without known CAD Methods and Results—From the Cleveland Clinic IRB approved MPI database, we identified consecutive patients without known CAD, who underwent stress MPI between 2006-2012 for diagnostic workup of syncope. Patients were stratified into low, intermediate and high risk using Framingham score. For patients with abnormal MPI, left heart angiograms (LHC) were reviewed if performed. There were 700 patients (mean age 62±15years, 55% female) who had undergone stress MPI for syncope; 659 (94%) with normal perfusion. Of the 41 patients with abnormal MPI, 18 had LHC (9 were false positive); there were 23 remaining patients with abnormal MPI (16 having moderate to severe PDS) but who did not have a LHC and could have undiagnosed significant CAD. The diagnostic yield of stress MPI was similarly low among all cardiovascular risk categories. Conclusions—Stress MPI for evaluation of syncope in patients without known CAD has a low diagnostic yield among all risk categories, and as such, reaffirmation and revision of the appropriateness criteria should be considered.