From the Research
For a patient with a normal ST-MPI result, the management plan should focus on cardiovascular risk factor modification and preventive care. Patients with normal stress test-myocardial perfusion imaging have an excellent prognosis with a very low risk of cardiac events (less than 1% per year), so invasive coronary evaluation or specific anti-ischemic therapy is not indicated. These patients should continue or initiate appropriate preventive measures including:
- Lifestyle modifications such as regular physical activity (at least 150 minutes of moderate-intensity exercise weekly)
- Heart-healthy diet (Mediterranean or DASH diet)
- Smoking cessation if applicable
- Weight management targeting a BMI of 18.5-24.9 kg/m² Medical therapy should be individualized based on the patient's risk factors, potentially including:
- Aspirin 81mg daily for selected high-risk patients
- Statins if LDL cholesterol is elevated (targeting LDL <70 mg/dL for high-risk patients), as supported by the US Preventive Services Task Force recommendation statement 1
- Appropriate management of hypertension (goal <130/80 mmHg) and diabetes (target HbA1c <7%) Regular follow-up is recommended with reassessment of cardiovascular risk annually, and repeat stress testing is not routinely needed unless new symptoms develop. This approach is based on the high negative predictive value of a normal ST-MPI, which effectively rules out significant obstructive coronary artery disease requiring intervention in the short to medium term, as seen in studies such as the one published in Circulation: Cardiovascular Imaging 2.