title: Prognostic implications of a normal stress technetium-99m-tetrofosmin myocardial perfusion study in patients with a healed myocardial infarct and/or previous coronary revascularization.
abstract: Previous studies have shown a good outcome for patients who present with normal findings on stress myocardial perfusion imaging. Currently, the prognostic implications of a normal study in patients who have a history of coronary artery disease (CAD) are not clear. This study investigated the long-term prognosis after a normal finding on stress technetium-99m (Tc-99m)-tetrofosmin single-photon emission computed tomography in patients with a history of CAD. The study included 147 consecutive patients with a history of CAD (previous myocardial infarction and/or myocardial revascularization), who underwent exercise bicycle or high-dose dobutamine-atropine stress Tc-99m-tetrofosmin single-photon emission computed tomography, and had normal perfusion results during stress and at rest. Follow-up was completed in all patients. During a follow-up of 6.5 +/- 1.9 years, 20 patients (14%) died, 10 (7%) of whom died due to cardiac causes, and 12 (8%) had a nonfatal myocardial infarction. Annual cardiac death rates were 0.5% during the first 3 years of follow-up and 1.3% in the subsequent 3 years. Independent predictors of cardiac death were male gender, rate-pressure product at rest, and rate-pressure product at peak stress. In conclusion, patients who have a history of CAD have a very low cardiac death rate during the 3 years after a normal finding on stress Tc-99m-tetrofosmin single-photon emission computed tomography. Repeated testing should be reconsidered 3 years after the initial evaluation and when a change in symptoms or clinical condition occurs.
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Aukje
authors.initials: A
authors.lastname: Huurman
authors.forename: Roelf
authors.initials: R
authors.lastname: Valkema
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rizzello
authors.forename: Harm H
authors.initials: HH
authors.lastname: Feringa
authors.forename: Eric P
authors.initials: EP
authors.lastname: Krenning
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D001794:Blood Pressure; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy; D003326:Coronary Circulation; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D009204:Myocardial Revascularization; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011379:Prognosis; D019275:Radiopharmaceuticals; D012737:Sex Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin