Role of the clinical radiopharmacist in patient safety during myocardial perfusion imaging with vasodilator stress agents

Aim

To assess the radiopharmacist’s role in a multidisciplinary team focused on the contraindications of regadenoson in order to ensure the safe use of pharmacologic vasodilator stress agents in patients undergoing SPECT-MPI.

Methods

We ambispectively studied its safe use in 1905 patients (54.1% female, mean age: 66.6 ± 11.7 years, range: 20–95 years). Sex, age, medical history, medications, drug allergies, and contraindications for stress testing were registered together with recommendations for the nuclear physician in charge.

Results

Detected contraindications and corresponding recommendations were as follows: risk factors for QTc interval prolongation 7.5% – measurement of QTc interval previously to test and monitor ECG; prior stroke or TIA 4.2% – consider carotid stenosis assessment; salicylates/sulfonamides allergy 3.1% – use ^99mTc-sestamibi; epilepsy or risk factors for seizures 2.4% – use of adenosine or reconsider test indication; systemic corticosteroid therapy for severe COPD 1.3% – reassessment of patient’s condition; acute exacerbation of COPD 0.8% – defer test until acute episode is over; severe asthma 0.4% – do not perform test; methylxanthine ingestion 0.3% – avoid consumption previously; other 6.1% – evaluation of other contraindications. No contraindications were detected in 73.6% of patients. The test was canceled due to absolute contraindications in 2.9% of the requests.

Conclusions

Working in a systematic way, the radiopharmacist was able to detect a high number of issues related to regadenoson, with one out of four patients presenting some clinical contraindication. The recommendations given by the radiopharmacist were well accepted by the nuclear physicians who changed their approach contributing to increase the safety of patients referred for MPI.