Key result
Withholding beta-blocker treatment for 72 hours before dipyridamole myocardial perfusion imaging did not significantly alter the diagnostic sensitivity for coronary artery disease compared to continuing therapy (91.7% vs 90.0%, p=0.945).
Why the study?
Does withholding beta-blocker treatment before dipyridamole myocardial perfusion imaging improve the diagnostic sensitivity for coronary artery disease in patients on long-term beta-blocker therapy?
RCT (n=120)
Single-blind
Permuted block randomization
Does withholding beta-blocker treatment before dipyridamole myocardial perfusion imaging improve the diagnostic sensitivity for coronary artery disease in patients on long-term beta-blocker therapy?
Withholding long-term beta-blocker therapy before dipyridamole myocardial perfusion imaging does not significantly improve diagnostic sensitivity for coronary artery disease, suggesting routine withdrawal is unnecessary.
Routine beta-blocker continuation is acceptable before dipyridamole MPI; confirms withholding confers no sensitivity gain in chronic users.
BACKGROUND: Although it has been shown that acute beta-blocker administration may reduce the presence or severity of myocardial perfusion defects with dipyridamole stress, little information is available about the potential effect of chronic beta-blocker treatment on the sensitivity of dipyridamole myocardial perfusion imaging (DMPI). METHODS: As a randomized clinical trial, one hundred twenty patients (103 male and 17 female) with angiographically confirmed CAD who were on long-term beta blocker therapy (≥3 months) enrolled in a randomized clinical trial study. The patients were allocated into two groups: Group A (n=60) in whom the beta-blocker agent was discontinued for 72h before DMPI and Group B (n=60) without discontinuation of beta-blockers prior to DMPI. RESULTS: No significant difference was noted between the groups concerning age, sex, type of the injected radiotracer and number of involved coronary vessels. The mean rank of total perfusion scores for whole myocardium (irrespective of reversibility or irreversibility) in group B was not significantly different from that of group A, (65.75 vs. 55.25, P=0.096). Regarding the only irreversible perfusion defects, the mean rank of perfusion score in group B was higher than that of group A for whole myocardium (72 vs. 49, P=0.0001); however, no difference was noted between two groups for only reversible perfusion defects (61.0 vs. 60.0, P=0.898). The overall sensitivity of DMPI for the diagnosis of CAD in group A (91.7%) was not statistically different from group B (90%). CONCLUSION: Beta-blocker withholding before DMPI did not generally affect the sensitivity of the test for the diagnostic purposes in our study. Thus, beta-blocker withdrawal for just the purpose of diagnostic imaging is not mandatory particularly when medication discontinuation may cause the patients to face increased risk of heart events.
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Fallahi et al. (2013) conducted an RCT in Coronary artery disease (n=120). Beta-blocker withholding vs. Continuation of beta-blockers was evaluated on Overall sensitivity of dipyridamole myocardial perfusion imaging (DMPI) for the diagnosis of CAD (p=0.945). Withholding beta-blocker treatment for 72 hours before dipyridamole myocardial perfusion imaging did not significantly alter the diagnostic sensitivity for coronary artery disease compared to continuing therapy (91.7% vs 90.0%, p=0.945).
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