title: Risk stratification of patients after myocardial revascularization by stress Tc-99m tetrofosmin myocardial perfusion tomography.
abstract: BACKGROUND
  The aim of this study was to assess the incremental prognostic value of stress technetium 99m tetrofosmin imaging after myocardial revascularization.
  
  
  RESULTS
  We studied 381 patients (aged 60 +/- 10 years, 270 men), 4.5 +/- 3.2 years after myocardial revascularization (coronary artery bypass grafting in 201 patients and percutaneous coronary intervention in 180 patients), who underwent exercise or dobutamine stress tetrofosmin single photon emission computed tomography. Events during a mean follow-up period of 3.5 +/- 1.4 years were cardiac death in 22 patients, nonfatal myocardial infarction in 11 patients (33 hard cardiac events), and late revascularization in 50 patients. There was no incidence of hard cardiac events in the 100 patients with normal perfusion. Hard cardiac events occurred in 19% of patients with reversible perfusion abnormalities and in 4% of patients without them (P <.01). The incidence of hard cardiac events was similar in patients with and without angina before stress testing (17/197 [8.6%] vs 16/184 [8.7%]). In a multivariate analysis model, predictors of cardiac death were stress rate pressure product and abnormal perfusion. Reversible perfusion abnormalities were independently associated with the composite endpoints of cardiac death, nonfatal myocardial infarction, and late revascularization. In an incremental multivariate analysis model, an abnormal scan was additive to clinical data in the prediction of hard cardiac events (model chi(2) = 17 vs 11, P <.01).
  
  
  CONCLUSIONS
  Stress Tc-99m tetrofosmin myocardial perfusion imaging provides independent prognostic information for the prediction of cardiac events after myocardial revascularization. Symptoms are not predictive of outcome, and therefore asymptomatic patients should not be deferred from stress testing. A normal study identifies a very low-risk population in whom no further intervention is required.
authors.affiliation: Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. Aelhendy@unmc.edu
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Arend F l
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Roelf
authors.initials: R
authors.lastname: Valkema
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D001285:Atropine; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D004280:Dobutamine; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011379:Prognosis; D019275:Radiopharmaceuticals; D018570:Risk Assessment / Q000379:methods*; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D004280:Dobutamine; C078700:technetium tc-99m tetrofosmin; D001285:Atropine