title: A negative myocardial perfusion scintigram after coronary angioplasty confers benign long-term prognosis.
abstract: BACKGROUND
  Myocardial perfusion SPECT is often used to exclude late restenosis or disease progression after coronary angioplasty (PTCA), but few studies have been published regarding the prognostic value of a negative study.
  
  
  OBJECTIVE
  To examine the long-term prognostic value of a non-ischemic SPECT result after successful PTCA.
  
  
  METHODS
  We retrospectively reviewed 783 patients (pts) who underwent scintigraphy 3 months to 3 years after successful PTCA. In 118 no significant myocardial ischemia (moderate or severe) was observed. There was a history of myocardial infarction (MI) in 38.1%, multivessel disease in 36.8% and LVEF < 50% in 15.3%. Referral for SPECT was chronic angina in 50.5% and acute coronary syndrome in 32.2%. SPECT was performed using a treadmill exercise test in 72%, adenosine in 21%, dipyridamole in 3% and dobutamine in 4%. Fifty-three percent of pts were under anti-ischemic medication. Patients were divided into two groups according to the SPECT result: group A pts (n = 70) had mild or no ischemia and group B pts (n = 48) had non-reversible defects of small or moderate size. The endpoint was the combined occurrence of death, MI, unstable angina (UA) and repeated revascularization.
  
  
  RESULTS
  There were one MI, 2 UA episodes and 4 repeated PTCAs (1 for UA). Event-free survival rate at two-year follow-up was slightly lower in patients from group B compared with group A, respectively 91.7% versus 97.1% (p = 0.16, log rank test).
  
  
  CONCLUSIONS
  This study suggests an excellent prognosis for patients with no or mild ischemia as assessed by SPECT performed more than 3 months after coronary angioplasty. Those patients with mild persistent defects did not present a significantly worse outcome.
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal. arteles@clix.pt
authors.forename: Rui Campante
authors.initials: RC
authors.lastname: Teles
authors.forename: K
authors.initials: K
authors.lastname: Reis-Santos
authors.forename: Victor
authors.initials: V
authors.lastname: Gil
authors.forename: António
authors.initials: A
authors.lastname: Ventosa
authors.forename: A Oliveira
authors.initials: AO
authors.lastname: Anão
authors.forename: João
authors.initials: J
authors.lastname: Calqueiro
authors.forename: F Pereira
authors.initials: FP
authors.lastname: Machado
authors.forename: Ricardo
authors.initials: R
authors.lastname: Seabra-Gomes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon