The value of stress single-photon emission computed tomography imaging performed routinely at 6 months in asymptomatic patients for predicting angiographic restenosis after successful direct percutaneous intervention for acute ST elevation myocardial infarction.
OBJECTIVE
The authors tested the value of stress single-photon emission computed tomography (SPECT) imaging performed systematically for detecting angiographic restenosis in asymptomatic patients who underwent direct percutaneous coronary intervention (PCI) for acute ST segment elevation myocardial infarction (STEMI). Angiographic restenosis of the infarct-related artery after direct PCI for STEMI is often silent and the strategy for follow-up evaluation of asymptomatic patients remains debated.


METHODS
A total of 149 patients successfully treated by direct PCI (96% stenting) for STEMI with no symptoms during the follow-up systematically underwent both rest thallium 201/stress Tc 99m setamibi myocardial perfusion imaging and coronary angiogram at 6 months. Patients were followed up for 2.5+/-0.5 years after 6 months control for cardiac events.


RESULTS
In the 149 patients, the sensitivity, specificity, positive and negative predictive values and accuracy of SPECT imaging were 48, 61, 35, 72 and 57%, respectively, for detecting binary angiographic restenosis defined as > or =50% diameter stenosis. Whether stress testing was maximal or performed after withheld anti-ischemic drugs did not improve the results. Reversible ischemia at SPECT in the infarct territory did not predict long-term cardiac events.


CONCLUSIONS
These data suggest a poor correlation between stress SPECT imaging and angiographic restenosis at 6 months in patients treated by direct PCI for STEMI who remain asymptomatic at follow-up. The long-term clinical prognostic value of SPECT reversible ischemia in the infarct territory appears also limited in this peculiar subset of patients. These findings should be taken into account in the strategy of the clinical follow-up of this population.
Isaaz
Karl
K
Department of Cardiology, Hôpital Nord, University of Saint Etienne, Centre Hospitalo-Universitaire de Saint Etienne, 42055 Saint Etienne Cedex 2, France. isaaz@univ-st-etienne.fr
Afif
Zahi
Z
Prévot
Nathalie
N
Cerisier
Alexis
A
Lamaud
Michel
M
Richard
Laure
L
Faure
Emmanuel
E
Granjon
Denise
D
Robin
Christophe
C
Hassan
Mohammed Sabry
MS
Da Costa
Antoine
A
Dubois
Francis
F
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000534:rehabilitation*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D017202:Myocardial Ischemia; D011237:Predictive Value of Tests; D011379:Prognosis; D015899:Tomography, Emission-Computed, Single-Photon