Comparison of long-term mortality risk following normal exercise vs adenosine myocardial perfusion SPECT

J Nucl Cardiol. 2010 Dec;17(6):999-1008. doi: 10.1007/s12350-010-9300-9. Epub 2010 Nov 13.


Background: A higher frequency of clinical events has been observed in patients undergoing pharmacological vs exercise myocardial perfusion single-photon emission computed tomography (SPECT). While this difference is attributed to greater age and co-morbidities, it is not known whether these tests also differ in prognostic ability among patients with similar clinical profiles.

Methods and results: We assessed all-cause mortality rates in 6,069 patients, followed for 10.2 ± 1.7 years after undergoing exercise or adenosine SPECT. We employed propensity analysis to match exercise and adenosine subgroups by age, gender, symptoms, and coronary risk factors. Within our propensity-matched cohorts, adenosine patients had an annualized mortality rate event rates that was more than twice that of exercise patients (3.9% vs 1.6%, P < .0001). Differences in mortality persisted among age groups, including those <55 years old. In the exercise cohort, mortality was inversely related to exercise duration, with comparable mortality noted for patients exercising <3 min and those undergoing adenosine testing.

Conclusions: Among patients with normal stress SPECT tests, those undergoing adenosine testing manifest a mortality rate that is substantially higher than that observed among adequately exercising patients, but comparable to that observed among very poorly exercising patients. This elevated risk underscores an important challenge for managing patients undergoing pharmacological stress testing.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenosine / chemistry*
  • Adult
  • Aged
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / mortality*
  • Exercise Test / adverse effects
  • Exercise Test / methods
  • Exercise*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardium / pathology*
  • Perfusion
  • Prognosis
  • Risk
  • Surveys and Questionnaires
  • Tomography, Emission-Computed, Single-Photon / methods*


  • Adenosine