title: When to stress patients after coronary artery bypass surgery? Risk stratification in patients early and late post-CABG using stress myocardial perfusion SPECT: implications of appropriate clinical strategies.
abstract: OBJECTIVE
  The study compared the prognostic significance of myocardial perfusion single-photon emission computed tomography (SPECT) (MPS) in patients early and late after coronary artery bypass graft surgery (CABG).
  
  
  BACKGROUND
  The long-term effectiveness of CABG is limited by graft stenosis. The greatest incidence of graft occlusion occurs between five and eight years after surgery. However, little is known regarding the appropriate time to stress patients post-CABG with respect to risk stratification.
  
  
  METHODS
  We identified 1,765 patients, who underwent MPS 7.1 +/- 5.0 years post-CABG. All patients underwent rest T1-201/stress Tc-99m sestamibi MPS and were followed up > or =1 year after testing. Patients with early CABG or PTCA (<60 days after MPS) were censored. The prognostic population consisted of 1,544 patients. A semiquantitative visual analysis employing a 20-segment model was used to define summed stress score (SSS), summed rest score (SRS), summed difference score (SDS), and the number of nonreversible segments (NRS).
  
  
  RESULTS
  During follow-up, 53 cardiac deaths (CD) occurred. There was a significant increase in annual CD rates as a function of SSS. A multivariate analysis identified age, ischemia (SDS), and infarct size (NRS) as independent predictors of CD. Nuclear variables added incremental value to prescan information. The annual CD rate was relatively low (1.3%) in patients < or =5 years post-CABG. In this subgroup only age and infarct size (NRS) were predictive of CD.
  
  
  CONCLUSIONS
  MPS is strongly predictive of subsequent CD in post-CABG patients and adds incremental value over clinical and treadmill test information. Our data suggest that symptomatic patients < or =5 years and all patients >5 years post-CABG may benefit from testing.
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Zellweger
authors.forename: H C
authors.initials: HC
authors.lastname: Lewin
authors.forename: S
authors.initials: S
authors.lastname: Lai
authors.forename: E A
authors.initials: EA
authors.lastname: Dubois
authors.forename: J D
authors.initials: JD
authors.lastname: Friedman
authors.forename: G
authors.initials: G
authors.lastname: Germano
authors.forename: X
authors.initials: X
authors.lastname: Kang
authors.forename: T
authors.initials: T
authors.lastname: Sharir
authors.forename: D S
authors.initials: DS
authors.lastname: Berman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D005080:Exercise Test; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon