Use of myocardial perfusion imaging to predict the effectiveness of coronary revascularisation in patients with stable angina pectoris.
OBJECTIVE
Coronary revascularisation is the treatment of choice in patients with stable angina who have significant stenoses. From a pathophysiological point of view, however, mitigation of angina is to be expected only in the presence of reversible ischaemia. Therefore it was the aim of this study to examine the effect of revascularisation on stable angina in relation to the myocardial perfusion imaging (MPI) pattern prior to intervention.


METHODS
Three hundred and eighty-four patients (58.0+/-8.8 years) referred for angiography underwent MPI. Prior to MPI and at 2-year follow-up, patients were classified as having typical angina, atypical angina, non-cardiac chest pain or no pain, and the severity of chest pain was graded according to the Canadian Cardiovascular Society (CCS) criteria. The patients themselves estimated their pain on a visual analogue scale. Management was based on symptoms and angiographic findings, since the results of MPI were not communicated.


RESULTS
Among the 240 patients who were not revascularised, 79% had typical or atypical angina at study entrance versus 40% at follow-up. In comparison, 93% of the 144 revascularised patients had typical or atypical angina before intervention versus only 36% at follow-up. This additional advantage of invasive therapy was present only in patients with reversible defects; revascularisation had no additional effect in patients with normal perfusion or irreversible defects. Similarly, additional, significant reductions in CCS class and visual analogue score were observed exclusively in patients with reversible defects.


CONCLUSIONS
In patients referred for coronary angiography owing to known or suspected stable angina, revascularisation was significantly more effective than medical treatment exclusively in patients with reversible ischaemia.
Johansen
Allan
A
Department of Clinical Physiology and Nuclear Medicine, Odense University Hospital, Odense, Denmark. allan.johansen@dadlnet.dk
Høilund-Carlsen
Poul Flemming
PF
Christensen
Henrik Wulff
HW
Vach
Werner
W
Møldrup
Mette
M
Haghfelt
Torben
T
D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control*; D011379:Prognosis; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome