Purpose: The selection of stress modality during MPI is influenced by multiple demographic and clinical factors. This study aimed to assess the clinical and demographic factors associated with the selection of pharmacologic versus exercise stress testing among patients undergoing MPI at a tertiary care center in Saudi Arabia.

Materials and methods: This retrospective single-center analytical study included adult patients who underwent MPI at a tertiary care hospital in Saudi Arabia. Patients were categorized into exercise stress testing and pharmacologic stress testing groups according to the stress modality utilized during MPI. Comparative analyses were performed using independent t test, chi-square test, and Fisher's exact test where appropriate.

Results: A total of 197 patients were included in the final analysis. Among them, 147 patients (74.6%) underwent pharmacologic stress testing, whereas 50 patients (25.4%) underwent exercise stress testing. Patients undergoing pharmacologic stress testing were significantly older than those undergoing exercise stress testing (59.8 ± 10.0 years vs. 55.9 ± 10.2 years, P = 0.02). Significant differences in sex distribution were also observed between the two groups (P = 0.006), with female patients being more frequently represented in the pharmacologic stress group. Patients undergoing pharmacologic stress testing demonstrated a greater prevalence of cardiovascular risk factors, obesity, and exercise-limiting comorbidities.

Conclusions: Pharmacologic stress testing represented the predominant stress modality among patients undergoing MPI at the tertiary care center. Advanced age, female sex, cardiovascular disease burden, and reduced exercise tolerance were associated with increased utilization of pharmacologic stress testing. These findings may serve as a foundation for the development of a standardized clinical protocol to guide stress modality selection in MPI.

Abdulaziz S. Alqahtani is a Consultant in Nuclear Medicine with clinical and academic interests in nuclear medicine, molecular imaging, and nuclear cardiology. He graduated from the University of Central Arkansas in the United States and subsequently worked for one year at CHI St. Vincent Infirmary in Little Rock, Arkansas. His research interests include

myocardial perfusion imaging and the optimization of stress testing protocols in nuclear cardiology. He is the first author of the published study, “Clinical Determinants of Pharmacologic Versus Exercise Stress Testing in Myocardial Perfusion Imaging: A Retrospective Single-Center Study in Saudi Arabia.” His academic interests focus on evidence-based practice, patient safety, and the optimization of nuclear medicine imaging protocols.