Exercise technetium-99m myocardial tomography for the risk stratification of men with medically treated unstable angina pectoris.
The prognostic value of predischarge maximal exercise stress testing with technetium-99m sestamibi (MIBI) myocardial tomography was assessed in 126 consecutive men hospitalized with a diagnosis of unstable angina pectoris who were medically stabilized. None had coronary revascularization for < or = 6 months after testing. Over a mean follow-up of 12 +/- 7 months (range 1 to 29), 35 patients (28%) had a cardiac event--nonfatal acute myocardial infarction (n = 6), cardiac death (n = 5), or rehospitalization for unstable angina (n = 24). Any type of cardiac event occurred in 12% of patients with normal MIBI scans, compared with 39% of those with an abnormal MIBI scan (p < 0.001) and 60% of those with a reversible perfusion defect (p < 0.0001). Only 2% of patients with normal scans had either a nonfatal myocardial infarction or cardiac death, compared with 14% of those with abnormal MIBI scans (p < 0.05) and 25% with a reversible defect (p < 0.001). A fixed perfusion defect was not associated with increased cardiac risk. With use of multivariable Cox proportional-hazards modeling, the only scintigraphic variable with independent predictive value was the presence of a reversible MIBI defect, with a relative risk of 3.8 (95% confidence interval 1.6 to 8.6, p < 0.05) for any cardiac event, and 19.2 (95% confidence interval 2.2 to 167.0, p < 0.05) for a nonfatal myocardial infarction or cardiac death. Cardiac event-free survival was also significantly decreased in patients with a reversible perfusion defect (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Stratmann
H G
HG
Department of Cardiology, St. Louis Veterans Administration Medical Center, Missouri 63106, USA.
Younis
L T
LT
Wittry
M D
MD
Amato
M
M
Miller
D D
DD
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality; D005080:Exercise Test / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011877:Radionuclide Imaging; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D017256:Technetium Tc 99m Sestamibi
D017256:Technetium Tc 99m Sestamibi