Absolute Contraindications for Myocardial Perfusion Imaging
Primary Contraindications
- The American College of Cardiology recommends that high-risk unstable angina, complicated acute coronary syndrome (ACS) or acute myocardial infarction (AMI) within 2 days, significant arrhythmias, and significant hypotension (systolic blood pressure <90 mmHg) are absolute contraindications for myocardial perfusion imaging (MPI) 1, 2
- Significant arrhythmias, such as ventricular tachycardia or second- or third-degree atrioventricular block, are contraindications for MPI, as recommended by the American College of Cardiology 1, 2
- Uncontrolled heart failure is a contraindication for MPI, according to the American College of Cardiology 1
- Sinus bradycardia <45 bpm is a contraindication for MPI, as stated by the American College of Cardiology 1
Vasodilator-Specific Contraindications
- Contraindications to vasodilator administration, such as known or suspected bronchoconstrictive or bronchospastic disease, are important considerations when using pharmacologic stress with adenosine, dipyridamole, or regadenoson, as noted by the American College of Cardiology and the American Heart Association 1, 2, 3
- Use of dipyridamole or methylxanthines within 12 hours before the test is a contraindication for MPI, as recommended by the American Heart Association 3
Radiation Considerations
- The European Journal of Nuclear Medicine and Molecular Imaging notes that radiation exposure should be considered, especially in younger patients or those requiring repeated imaging, with radiation exposure varying by tracer: 10 mSv for tetrofosmin, 12 mSv for MIBI, and 18 mSv for thallium-201 4, 5
Clinical Implications
- The American College of Cardiology and the European Heart Journal state that understanding these contraindications is essential for patient safety, as MPI is otherwise considered a relatively safe procedure with a complication rate of approximately 0.01% deaths and 0.02% morbidity, and alternative imaging modalities such as stress echocardiography or cardiovascular magnetic resonance imaging may be considered based on local expertise and availability 1, 2, 4, 5, 6