Tolerance and diagnostic accuracy of an abbreviated adenosine infusion formyocardial scintigraphy: A randomized, prospective study

Background. The objectives of this study were 2-fold: (1) to determine the tolerance of adenosine perfusion tomography with the use of an abbreviated (3-minute) infusion in comparison to the standard (6-minute) infusion, and (2) to assess the relative diagnostic accuracy of a 3-minute adenosine infu sion in patients referred for arteriography. An abbreviated adenosine infus ion may decrease the frequency and duration of side effects and be a more c ost-effective alternative. Methods and Results. We prospectively randomized 599 patients undergoing ad enosine myocardial perfusion tomography to either a 3-minute or 6-minute ad enosine infusion at 140 mug/kg per minute. Among the 599 enrolled patients, 142 subsequently underwent coronary angiography. Patients randomized to th e 3-minute adenosine infusion tolerated the procedure better than those ran domized to the standard infusion (P<.01). Flushing, headache, neck pain, an d atrioventricular block were all significantly less frequent (P<.01) with the abbreviated infusion. Moreover, patients receiving the abbreviated infu sion had less hypotension and tachycardia (P<.05). The sensitivity of the t est for detection of coronary artery disease was 88% for both the 3- and 6- minute infusions. In patients with abnormal scan results, perfusion defect size was slightly larger in those receiving a 6-minute infusion versus thos e receiving a 3-minute infusion (P=.05). Conclusions. An abbreviated 3-minute adenosine infusion, in combination wit h perfusion tomography, has similar sensitivity for detection of coronary a rtery disease and is better tolerated than the standard 6-minute infusion.