Prediction of death or myocardial infarction by exercise single photon emission computed tomography perfusion scintigraphy in patients who have had recent coronary artery stenting.
BACKGROUND
Although practice guidelines do not recommend routine exercise testing of patients after coronary stenting, several small studies have suggested that stress myocardial perfusion imaging can provide prognostic information about future adverse cardiac events. We sought to determine if exercise nuclear testing provides independent prognostic information in patients after coronary stenting.


METHODS
We analyzed the outcomes of 370 patients who underwent dual isotope exercise nuclear scintigraphy at least 1 month after coronary stenting and had testing between April 1996 and May 2002. Patients were classified according to presence or absence of any ischemia. The primary endpoint was all-cause mortality or myocardial infarction (MI) during a median of 30 months (range 6-59) of follow-up.


RESULTS
There were 86 patients (23%) who had ischemia. Major events--death or MI--occurred in 62 patients including 22 deaths. Among patients with no ischemia, the 30-month event rate was 9.1%, whereas among patients with ischemia, the event rate was 17.0% (P = .001). After adjusting for age, sex, standard cardiac risk factors, cardiac history, left ventricular ejection fraction, angiographic findings, procedural variables, exercise capacity, and heart-rate dynamics, the presence of scintigraphic evidence of ischemia predicted death or MI (adjusted hazard ratio 2.08, 95% CI 1.21-3.56, P = .008). The presence of ischemia similarly predicted events in asymptomatic patients (adjusted hazard ratio 2.19, 95% CI 1.17-4.11, P = .015).


CONCLUSIONS
In patients with recent coronary stent placement, reversible nuclear perfusion defects independently predicted risk of death or MI.
Rajagopal
Vivek
V
Department of Cardiovascular, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Gurm
Hitinder S
HS
Brunken
Richard C
RC
Pothier
Claire E
CE
Bhatt
Deepak L
DL
Lauer
Michael S
MS
D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D018572:Disease-Free Survival; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality*; D017202:Myocardial Ischemia / Q000453:epidemiology; D011237:Predictive Value of Tests; D011897:Random Allocation; D018570:Risk Assessment / Q000379:methods; D017678:Sex Distribution; D015607:Stents / Q000706:statistics & numerical data*; D015899:Tomography, Emission-Computed, Single-Photon