Stress/rest myocardial perfusion scintigraphy in patients without significant coronary artery disease.
OBJECTIVE
To define the prognostic impact of stress myocardial perfusion scintigraphy (MPS) in patients with angiographic exclusion of significant coronary artery disease.


METHODS
Angiographic and MPS databases were matched to define patients without significant coronary artery disease by quantitative angiography (diameter stenosis <50%) who underwent stress MPS and coronary angiography within a time period of 3 months. A total of 118 patients were identified and followed for a mean of 6.3 +/- 1.2 years for death, a composite of death, myocardial infarction, bypass surgery, or percutaneous coronary intervention [MAE]) as well as occurrence of symptoms (angina or dyspnoe class CCS II to IV). Stress and rest MPS (using (99m)Tc-MIBI or tetrofosmin) were analyzed by quantitative perfusion SPECT (QPS) for summed stress and rest scores (SSS/SRS).


RESULTS
There were 16 deaths, 29 MAE, and 76 patients with MAE or significant symptoms during follow-up. Significant differences in SSS were found between patients who died (9.5 +/- 6.9 vs. 5.4 +/- 5.6, P = 0.012), had MAE (8.7 +/- 7.2 vs. 5.2 +/- 5.0, P = 0.010), or had MAE or significant clinical symptoms (7.2 +/- 7.1 vs. 4.6 +/- 6.2, P = 0.042) compared to those without the respective event. Logistic regression analysis demonstrated SSS to be a predictor of death (OR = 1.074 [95% CI: 1.004-1.149], P = 0.026) and MAE (OR = 1.087 [95% CI: 1.004-1.181], P = 0.027).


CONCLUSIONS
In patients without significant angiographic coronary artery disease, the result of stress MPS is a predictor of long-term prognosis. Quantitative analysis of MPS allows definition of patients with a higher likelihood to develop clinical events or symptoms.
Adamu
Umar
U
Medical Clinic I, University RWTH Aachen, Pauwelsstrasse 30, 52057, Aachen, Germany.
Knollmann
Daniela
D
Almutairi
Bader
B
Alrawashdeh
Wael
W
Deserno
Verena
V
Vogt
Felix
F
Kleinhans
Eduard
E
Schäfer
Wolfgang M
WM
Hoffmann
Rainer
R
D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D017682:Myocardial Stunning / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011859:Radiography; D015203:Reproducibility of Results; D012146:Rest; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology*
J Nucl Cardiol. 2008 Nov-Dec;15(6):754-61
18984450
Clin Nucl Med. 2008 Nov;33(11):743-7
18936603
J Am Coll Cardiol. 1996 Jun;27(7):1612-20
8636545
J Nucl Cardiol. 2006 Jul;13(4):495-506
16919573
Circulation. 1996 Mar 1;93(5):905-14
8598081
Circulation. 2003 Sep 16;108(11):1404-18
12975245
Circulation. 1998 Feb 17;97(6):535-43
9494023
J Nucl Cardiol. 1999 May-Jun;6(3):252-6
10385180
Circ Cardiovasc Imaging. 2008 Nov;1(3):180-8
19808541
Circulation. 1992 Jan;85(1):237-48
1728455
Am J Cardiol. 2006 Sep 1;98(5):585-90
16923441
J Am Coll Cardiol. 1998 Dec;32(7):1987-95
9857883
Circulation. 1988 Apr;77(4):745-58
3258193
Am J Cardiol. 2006 May 15;97(10):1452-4
16679082
J Am Coll Cardiol. 2007 Jan 16;49(2):227-37
17222734
J Nucl Cardiol. 2006 Mar-Apr;13(2):191-201
16580955
J Am Coll Cardiol. 1995 Sep;26(3):639-47
7642853