[Prognosis of patients with angina pectoris or silent ischemia: exercise 99mTC-MIBI SPECT].
OBJECTIVE
Although different reports have compared the extent of the myocardial ischemia in patients with or without angina during exercise test, there have been few publications which have studied their prognosis. The aim of this study is to analyze the prognostic value of the presence of angina during 99mTc-MIBI SPECT in patients with proven coronary artery disease without previous myocardial infarction.


METHODS
We studied 82 patients prospectively with at least one coronary stenosis > 70% and with reversible perfusion defects in 99mTc-MIBI SPECT (long protocol). Twenty two of these patients had angina during exercise test. The extension of ischemia was quantified on SPECT and the severity of coronary stenoses on coronary angiography. The mean follow-up period was 3.2 years.


RESULTS
The angina patients showed a significantly lower coronary reserve (exercise duration: 6.3 min vs 8 min; p = 0.03), a lower maximal O2 consumption (5.8 METs vs 6.2 METs; p = 0.04), a higher rate of ST depression > 1 mm (64% vs 19%; p = 0.006) and a higher degree of ST depression (0.9 mm vs 0.4 mm; p = 0.01) than those patients without angina. There were no significant differences in the extent of ischemia in SPECT or in the angiographic severity of coronary disease between either groups. During the follow-up period the presence of severe complications (myocardial infarction or death) tended to be higher (27% vs 17%; NS) in patients with angina and the indication of surgical revascularization was also significantly higher (50% vs 17%; p = 0.002) in this group.


CONCLUSIONS
Presence of angina during 99mTc-MIBI SPECT portends a higher risk of medium and long term complications, mainly due to surgical revascularization.
Santana-Boado
C
C
Servicio de Cardiología, Hospital General Universitari Vall d'Hebron, Barcelona.
Figueras
J
J
Candell-Riera
J
J
Bermejo
B
B
Cortadellas
J
J
Castell
J
J
Aguadé
S
S
Soler-Soler
J
J
D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000401:mortality; D017023:Coronary Angiography; D003627:Data Interpretation, Statistical; D004562:Electrocardiography; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
Pronóstico de los pacientes con angina y con isquemia silente en la tomogammagrafía de esfuerzo con 99mTc-MIBI.