Usefulness of stress myocardial perfusion imaging for evaluating asymptomatic patients after coronary stent implantation.
BACKGROUND
Stent implantation in coronary angioplasty has reduced the rate of restenosis, but many patients still undergo follow-up coronary angiography (CAG). The present study was a multi-center retrospective analysis of the usefulness of stress single photon emission computed tomography (SPECT) compared with follow-up CAG in stent-implanted patients who remained asymptomatic during the follow-up period.


RESULTS
The study group of 103 patients underwent both SPECT and CAG at 4-9 months after stent implantation. Restenosis occurred in 20 (19%) of 106 vessel territories, and a reversible perfusion defect was found in 32 (30%) territories. Sensitivity, specificity, positive and negative predictive values, and accuracy of SPECT were 65%, 78%, 41%, 91%, and 76%, respectively. The accuracy was lower in territories with a prior myocardial infarction (71%), in the left circumflex artery (58%), and in cases with three-vessel disease (63%). The negative predictive value was high, but 7 false negative cases included 4 cases with prior myocardial infarction, and 2 cases with reversible defects in other vessel territories.


CONCLUSIONS
Stress SPECT imaging is a useful tool for following up patients with coronary stent implantation, and follow-up CAG could be omitted in patients with negative SPECT imaging, no prior myocardial infarction, one- or two-vessel disease, and sufficient stress loading.
Sugi
Toshihiko
T
Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Satoh
Hiroshi
H
Uehara
Akihiko
A
Katoh
Hideki
H
Terada
Hajime
H
Matsunaga
Masaki
M
Yamazaki
Keisuke
K
Matoh
Fumitaka
F
Nakano
Tomoyasu
T
Yoshihara
Shu
S
Kurata
Chinori
C
Miyata
Haruo
H
Ukigai
Hiroshi
H
Tawarahara
Kei
K
Kimura
Masahiko
M
Suzuki
Shingo
S
Hayashi
Hideharu
H
D000368:Aged; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis*; D005080:Exercise Test; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015607:Stents; D015899:Tomography, Emission-Computed, Single-Photon