Prognostic value of exercise myocardial scintigraphy in patients with coronary chronic total occlusions.
OBJECTIVE
To evaluate the prognostic value of exercise myocardial scintigraphy in patients undergoing incomplete revascularization by means of percutaneous coronary intervention (PCI) with at least a residual chronic total occlusion (CTO) left untreated.


METHODS
Of 569 consecutive patients with multivessel disease undergoing myocardial scintigraphy after incomplete revascularization by PCI between March 1997 and December 2004, 126 (79% male, 64+/-10 years) with >or= 1 residual CTO fulfilled the eligibility criteria and entered in the study. Hard events defined as cardiac death and myocardial infarction, soft events defined as incidence of unstable angina and PCI procedures, and their composite were assessed at a median follow-up period of 44 months.


RESULTS
Hard events were observed in six patients (4.8%). All of them had severely abnormal perfusion defects detected by myocardial scintigraphy. Soft events occurred in 0 (0%), 10 (7.9%), and 15 (11.9%) patients with normal, mildly abnormal, and severely abnormal perfusion, respectively. In the Kaplan-Meier analysis, the log-rank test was statistically significant across patients stratified by summed stress score either in terms of hard, soft and hard, or soft events. Univariate and multivariate Cox proportional-hazards showed an incremental significant information when the scintigraphic variables were added to clinical, angiographic, left ventricular ejection fraction, and Duke treadmill score, for prediction of the composite of hard and soft cardiac events (P < 0.006).


CONCLUSIONS
Among patients with a residual CTO left untreated after PCI, myocardial perfusion imaging provides significant independent information concerning the subsequent risk of cardiac events.
Clinical Division of Cardiology, Department of Internal Medicine and Systemic Disease, Ferrarotto Hospital, University of Catania, Catania, Italy. argalassi@virgilio.it
Alfredo R
AR
Galassi
Gerald S
GS
Werner
Salvatore D
SD
Tomasello
Salvatore
S
Azzarelli
Davide
D
Capodanno
Giombattista
G
Barrano
Francesco
F
Marza'
Luca
L
Costanzo
Mariabarbara
M
Campisano
Corrado
C
Tamburino
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D002908:Chronic Disease; D017023:Coronary Angiography; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D005080:Exercise Test / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000592:standards*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D015899:Tomography, Emission-Computed, Single-Photon
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin