Residual exercise SPECT ischemia on treatment is a main determinant of outcome in patients with coronary artery disease treated medically at long-term with beta-blockers.
BACKGROUND
Beta-blockers are potent anti-ischemic medications, able to improve prognosis in patients with coronary artery disease (CAD). However, it is not known whether beta-blockers have the same beneficial prognostic effect when residual ischemia persists on treatment.


RESULTS
The prognostic impact of exercise single photon emission computed tomography (SPECT) ischemia was analyzed in 442 patients with chronic CAD, who were treated with beta-blockers and who were referred to exercise thallium 201 SPECT, while they were receiving their daily-life medications. Ischemic and viable myocardium was documented on Tl-201 SPECT in 190 patients (43%), of whom only 23% had angina and only 26% had positive exercise testing results. During a follow-up of 3.8 +/- 1.7 years, 36 patients died and survival curves were progressively divergent between patients with and those without ischemic and viable myocardium: at 5 years, the respective survival rates were 81% +/- 4% and 94% +/- 2% (P =.004). By multivariate analysis, the best independent predictors of death were large extent of necrosis (>25% of left ventricle on Tl-201 SPECT, P <.001) and ischemic and viable myocardium (P =.001).


CONCLUSIONS
In the CAD patients treated on a long-term basis with beta-blockers, survival is strongly influenced by persistent exercise SPECT ischemia on treatment. Therefore exercise SPECT on treatment could be a useful tool for selecting those who might benefit from additional anti-ischemic therapeutic interventions.
Marie
Pierre Y
PY
Department of Nuclear Medicine and Cardiology, UPRES EA 3447, CHU Nancy-Brabois, 54511 Vandoeuvre Cedex, France. py.marie@chu-nancy.fr
Mercennier
Christelle
C
Danchin
Nicolas
N
Djaballah
Karim
K
Grentzinger
Alain
A
Zannad
Faïez
F
Olivier
Pierre
P
Djaballah
Wassila
W
Karcher
Gilles
G
Virion
Jean M
JM
Bertrand
Alain
A
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000401:mortality; D018572:Disease-Free Survival; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019275:Radiopharmaceuticals; D016019:Survival Analysis; D015996:Survival Rate; D013793:Thallium; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D019275:Radiopharmaceuticals; C027549:thallium chloride; D013793:Thallium