Guideline for Rest and Stress Myocardial Perfusion Scintigraphy

Indications: 1. Symptomatic patients or patients with ECG suggestive of ischemia, with intermediate or high pre-test probability; 2. Symptomatic patients or patients with ECG suggestive of ischemia, with low pre-test probability who are unable to perform a stress test, or with an uninterpretable ECG (left branch block, preexcitation, medication that interferes with the ECG or with chronotropism); 3. Asymptomatic patients with high pre-test probability of coronary artery disease, calcium score between 100-400 or > 400 and intermediate risk; 4. Moderate-risk pre-operative patients of non-cardiac surgery or vascular surgery with one or more risk factors and poor functional capacity: a. Clinical risk factors: previous history of coronary artery disease (CAD), history of heart failure, history of cerebrovascular disease, diabetes mellitus or kidney failure (serum creatinine over 2 mg/dL); 5. General surgery pre-operative stratification in patients with confirmed heart disease: recent acute myocardial infarction (AMI) – last six months, unstable angina, decompensated heart failure and severe valve disease; 6. High or intermediate risk general surgery preoperative stratification in patients with functional capacity ≤ 4 METS, or patients whose functional capacity is impossible to assess when at least one of the following risk factors is present: previous history of CAD, history of heart failure, history of cerebrovascular disease, diabetes mellitus, or kidney failure (serum creatinine over 2 mg/dL); 7. After coronary artery bypass surgery (>3 months) in symptomatic patients, if the surgery was incomplete, or if the procedure was over five years before; 8. Patients with known coronary anatomy, with need for identification of the vessel related to the ischemia (definition of the hemodynamic meaning of coronary lesions); 9. Assessment of myocardial viability in severe ventricular dysfunction patients (left ventricle ejection fraction < 40%) with suspected or confirmed CAD; 243 International Journal of Cardiovascular Sciences. 2016;29(3):243-247