Myocardial perfusion abnormalities early (12-24 h) after coronary stenting or balloon angioplasty: implications regarding pathophysiology and late clinical outcome.
OBJECTIVE
We prospectively examined the prevalence of reversible perfusion defects on very early (12-24 h) thallium-201 single photon emission computed tomography (SPECT) scintigraphy after angiographically successful percutaneous coronary intervention (PCI) by stenting and/or stand-alone balloon angioplasty and the predictive value of these defects for late target lesion revascularization (TLR).


METHODS
83 consecutive patients undergoing PCI for 88 lesions (38 balloon angioplasties, 50 stents) underwent very early (12-24 h) SPECT thallium-201 scintigraphy at rest and following administration of 0.7 mg/kg intravenous dipyridamole after PCI. Univariate and multivariate clinical, procedural and scintigraphic correlates of target lesion revascularization during long-term follow-up were examined.


RESULTS
Coronary stenting achieved a larger immediate post-PCI minimal luminal dimension (2.7 +/- 0.4 vs. 2.1 +/- 0.4 mm, p < 0.001) and less residual stenosis (4 +/- 12 vs. 19 +/- 11%, p < 0.001) than stand-alone balloon angioplasty. Nonetheless, early reversible perfusion defects were similarly present in the territory supplied by 36% of stented lesions and 32% of lesions treated by balloon angioplasty (NS). Of 81 lesions (76 patients) available for long-term clinical follow-up, TLR was performed in 11% of the stent group and 14% of the balloon angioplasty group (NS). By multivariate logistic regression analysis, diabetes mellitus was the only predictor of late TLR (p < 0.05). The type of intervention (balloon or stent) predicted neither early perfusion defects nor late TLR.


CONCLUSIONS
Early 201-thallium SPECT scintigraphy was abnormal in a third of patients treated by stand-alone balloon angioplasty or by stent placement. The very early SPECT scintigraphic findings did not differentiate between balloon and stent and did not predict late TLR.
Jaffe
Ronen
R
Department of Cardiology, Lady Davis Carmel Medical Center and the Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel.
Haim
Simona Ben
SB
Karkabi
Basheer
B
Front
Avi
A
Gips
Sara
S
Weisz
Giora
G
Khader
Nader
N
Merdler
Amnon
A
Flugelman
Moshe Y
MY
Halon
David A
DA
Lewis
Basil S
BS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D019917:Blood Vessel Prosthesis Implantation; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015428:Myocardial Reperfusion Injury / Q000209:etiology* / Q000503:physiopathology; D010477:Perfusion / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D015607:Stents; D013794:Thallium Radioisotopes; D013995:Time; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D013794:Thallium Radioisotopes