[Analysis of the number of patients needed to treat by coronary revascularisation in relation to the presence of myocardial viability in gated SPECT images: a prospective cohort study from a nuclear cardiology unit].
OBJECTIVE
To evaluate the number of patients needed to treat (NNT) to assess the magnitude of benefit of coronary revascularisation (CR) in patients with ischaemic cardiomyopathy (IC) in relation to the presence or absence of myocardial viability in myocardial perfusion gated-SPECT (single photon emission computed tomography) images.


METHODS
We studied 198 consecutive patients with IC using rest gated-SPECT with technetium-based agents. The cardiac mortality was analysed in four groups: viable with CR (n = 50), viable with medical treatment (MT) (n = 90), non-viable with CR (n = 18), and non-viable with medical treatment (n = 40).


RESULTS
During 2.3 +/- 1.2 years of follow-up, the cardiac mortality rate in patients with scintigraphic viability criteria undergoing revascularisation was 5.9/100 patients/year and 12.9/100 patients/year in those who received medical treatment. In patients without viability who underwent revascularisation, the cardiac mortality rate was 6.2/100 patients/year and in those who received MT it was 1.9/100 patients/year. In patients with myocardial viability the NNT was 4, while in patients without myocardial viability, the NNT was 24.


CONCLUSIONS
In patients with scintigraphic viability criteria, the NNT to obtain one survival with CR was 6 times lower with respect to patients without viability, with lower cost and mortality.
Romero Farina
G
G
Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
Ferreira
I
I
Aguadé-Bruix
S
S
Castell-Conesa
J
J
Igual
A
A
Candell-Riera
J
J
D000368:Aged; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D002470:Cell Survival; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000706:statistics & numerical data*; D006321:Heart / Q000000981:diagnostic imaging*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D032383:Myocytes, Cardiac / Q000000981:diagnostic imaging / Q000473:pathology; D009684:Nuclear Medicine Department, Hospital / Q000706:statistics & numerical data*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D018401:Sample Size; D013030:Spain / Q000453:epidemiology; D013318:Stroke Volume; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin; D017256:Technetium Tc 99m Sestamibi