Key result
Normal MPI scans rise to ~62% over two decades despite stable pretest probability.
Why the study?
Normal test results have increased alongside decreasing CAD prevalence and pre-test probability overestimation, prompting an evaluation of temporal trends in normal myocardial perfusion imaging scans over 23 years.
Have the rates of normal myocardial perfusion imaging scans and pretest probability changed over time between 2000 and 2023?
Have the rates of normal myocardial perfusion imaging scans and pretest probability changed over time between 2000 and 2023?
The proportion of normal myocardial perfusion imaging scans significantly increased over 23 years despite unchanged pretest probability, suggesting a need for better patient preselection to reduce unnecessary diagnostic tests.
Rising normal MPI rates despite stable PTP may reflect referral shifts; leaves open whether refined preselection optimizes testing efficiency.
Introduction A high proportion of patients referred for coronary artery disease (CAD) testing with myocardial perfusion imaging (MPI) have normal test results. With decreasing prevalence of CAD and overestimation of pre-test probability (PTP) by existing models, normal tests results have continuously increased over time. Purpose This study aimed to evaluate temporal trends of normal scan results over 23 years in a large referral center in Switzerland. Material & Methods Data from all available MPI scans (Single Photon Emission Computed Tomography and Positron Emission Tomography) performed between 2000 and 2023 were extracted from the electronic medical record. An abnormal scan result was defined as Summed Stress Score (SSS) ≥4. PTP according to the 2019 ESC guidelines on chronic coronary syndromes was calculated. Temporal trends of Summed Rest Score (SRS), Summed Difference Score (SDS) and SSS were also analyzed. Results Overall, 45’113 patients were analyzed. The mean age was 66 ± 11 years, 35% were female. Typical and atypical angina were reported in 22% and 24%, respectively. Overall, MPI was abnormal in 44%. Small (SDS ≥2) and relevant (≥10% myocardium involved) ischemia was observed in 36% and 13%, respectively. The proportion of normal scan results increased from 53% in 2000 to 62% in 2023 (p < 0.001) (figure 1). SRS and SSS, but not SDS decreased over time (figure 2). In multivariate regression analysis, the year of exam was a significant predictor for normal MPI (OR 1.026 (95% CI 1.023-1.029), p < 0.001). PTP remained unchanged over time (20% in 2000 vs. 21% in 2023) (figure 1). Conclusion The proportion of normal scan results significantly increased over 23 years, whereas PTP remained unchanged. To counter this trend and reduce unnecessary diagnostic tests, patient preselection must further be optimized.
No takes yet. Share an insight, caveat, or question.
Schneider et al. (2025) studied this question. The proportion of normal myocardial perfusion imaging results increased from 53% in 2000 to 62% in 2023 despite stable pretest probability (20% to 21%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: