title: Myocardial perfusion scintigraphy to predict outcomes after coronary stenting.
abstract: The value of myocardial perfusion scintigraphy (MPS) in predicting the occurrence of restenosis or new coronary lesions after stent implantation is debatable. A total of 47 patients treated with successful bare stent implantation underwent stress gated SPECT MPS at three time-points: pre-procedure, early pos-procedure, and 6-month follow-up. Follow-up angiographic re-study was obtained at 6 months. Overall, 51.1% of patients had angiographic in-stent restenosis or a new lesion at follow-up. Pre-procedure MPS and early MPS scans did not differ between patients with or without restenosis/new lesions. At follow-up transient perfusion defects were observed in 26.1% of patients without restenosis/new lesions and in 75.0% of patients presenting with restenosis/new lesions (p<0.01) (sensitivity: 75.0%; especificity: 73.9%). When comparing early post procedure MPS to follow-up MPS, patients without restenosis/new lesions had no changes or a decrease in the number of segments with transient defects (median difference 0 [interquartile range -2 - 0]), while patients with restenosis/new lesions had an increase in transient defects (+2 [interquartile range 2 - 3.75]; p<0.01). Two multivariate factors independently predicted new lesion/restenosis: reference diameter < 2.9 mm (OR 6.50; p=0.05) and the difference in the number of segments with transient defects between early post procedure and follow-up MPS (OR 1.87; p<0.01). In conclusion, pre-procedure and early MPS did not predict complications after coronary stenting, while follow-up MPS was suboptimal in differentiating patients with or without new lesions/restenosis. However, the change in myocardial perfusion from early post-procedure to the follow-up scan was an important -prognostic factor to predict the incidence of new lesion/restenosis.
authors.affiliation: Interventional Cardiology Service, Heart Institute (InCor), University of São Paulo Medical School, Brazil.
authors.forename: Silvio
authors.initials: S
authors.lastname: Zalc
authors.forename: John A
authors.initials: JA
authors.lastname: Ambrose
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.forename: Expedito E
authors.initials: EE
authors.lastname: Ribeiro
authors.forename: José
authors.initials: J
authors.lastname: Soares
authors.forename: Maria C P
authors.initials: MC
authors.lastname: Giorgi
authors.forename: Antonio
authors.initials: A
authors.lastname: Esteves-Filho
authors.forename: Pedro E
authors.initials: PE
authors.lastname: Horta
authors.forename: José C
authors.initials: JC
authors.lastname: Meneghetti
authors.forename: José A F
authors.initials: JA
authors.lastname: Ramires
authors.forename: Eulógio E
authors.initials: EE
authors.lastname: Martinez