Prognostic value of myocardial perfusion tomographic imaging in patients after percutaneous transluminal coronary angioplasty.
OBJECTIVE
The authors assessed the prognostic value of stress myocardial perfusion tomographic imaging (SPECT) in patients with recurrent angina or inconclusive results of exercise electrocardiographic tests after successful percutaneous transluminal coronary angioplasty (PTCA).


METHODS
After PTCA, 70 patients (54 men, 16 women; 41 after myocardial infarction; mean age, 56 +/- 9 years) underwent TI-201 or Tc-99m sestamibi SPECT studies. SPECT patterns were divided into normal (n = 25), fixed defects (n = 15), and reversible or combined fixed plus reversible defects (n = 30). A cardiac event was defined as either cardiac death, nonfatal myocardial infarction, or unstable angina requiring further revascularization.


RESULTS
During an average follow-up of 25 +/- 10 months, two patients had severe outcomes (one cardiac death and one nonfatal myocardial infarction), and revascularization was required in 13 patients. In patients with normal SPECT or fixed defects, the annual event rate was low (1.2%), with only one revascularization. In patients with reversible or combined defects, the annual event rate was significantly greater (22.4%; chi square = 17.32, P = 0.00003).


CONCLUSIONS
Normal perfusion or fixed defects predict a benign prognosis in patients after successful PTCA. The presence of stress-induced reversible defects appears to be the best predictor of future cardiac events.
Kamínek
M
M
Department of Nuclear Medicine, University Hospital, Olomouc, Czech Republic. milan.kaminek@fnol.cz
Myslivecek
M
M
Myslivecek
M
M
Husák
V
V
Koranda
P
P
Lang
O
O
D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000503:physiopathology; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D018570:Risk Assessment / Q000379:methods; D016019:Survival Analysis; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi