Prognostic value of dobutamine-atropine stress technetium-99m sestamibi perfusion scintigraphy in patients with chest pain.
OBJECTIVE
This study investigated the prognostic value of dobutamine-atropine technetium-99m (Tc-99m) sestamibi single-photon emission computed tomographic (SPECT) myocardial perfusion imaging.


BACKGROUND
Dobutamine-atropine Tc-99m sestamibi SPECT imaging is an accurate method for the detection of coronary disease. However, the prognostic value of this stress modality has not been assessed.


METHODS
Three hundred ninety-two consecutive patients with chest pain (mean [+/- SD] age 60 +/- 12 years; 220 men, 190 with a previous myocardial infarction) underwent a dobutamine-atropine Tc-99m sestamibi SPECT scintigraphic study. Patients were followed up for 22 +/- 13 months to determine the univariate and multivariate variables associated with hard cardiac events (cardiac death, nonfatal myocardial infarction), to define their event-free survival and to determine whether the extent and severity of reversible perfusion defects correlated with events.


RESULTS
Forty-four patients (11%) had hard cardiac events. Multivariate models demonstrated that older age (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.0 to 4.4), history of heart failure (OR 2.6, 95% CI 1.3 to 5.2), abnormal sestamibi scan results (OR 10.0, 95% CI 2.3 to 43.0) and reversible perfusion defects (OR 3.2, 95% CI 1.6 to 6.4) had independent predictive value. Patients without perfusion defects, with fixed defects alone, reversible defects alone and fixed plus reversible defects had annual hard cardiac event rates of 0.8%, 6.8%, 8.1% and 11.6%, respectively. Patients with increasing reversible defect scores had increasing annual event rates of 2.1%, 5.0%, 5.5%, 13.0% and 14.6%, respectively.


CONCLUSIONS
Dobutamine-atropine stress Tc-99m sestamibi SPECT imaging provides excellent prognostic information. The single most important independent predictor for future hard cardiac events is an abnormal pattern, and a reversible defect provides additional, independent prognostic information. Moreover, the extent and severity of reversible defects are major determinants for prognosis.
Geleijnse
M L
ML
Thoraxcentre, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Elhendy
A
A
van Domburg
R T
RT
Cornel
J H
JH
Reijs
A E
AE
Roelandt
J R
JR
Krenning
E P
EP
Fioretti
P M
PM
D001285:Atropine; D002637:Chest Pain / Q000000981:diagnostic imaging*; D018572:Disease-Free Survival; D004280:Dobutamine; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D013566:Sympathomimetics; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
D013566:Sympathomimetics; D004280:Dobutamine; D001285:Atropine; D017256:Technetium Tc 99m Sestamibi