title: Prognostic value of stress-gated 99m-technetium SPECT myocardial perfusion imaging: risk stratification of patients with multivessel coronary artery disease and prior coronary revascularization.
abstract: BACKGROUND
  This study assessed the prognostic value of stress-gated 99mTc-sestamibi myocardial perfusion SPECT (MPS) in patients with multivessel coronary artery disease (CAD) and prior revascularization according to the presence and severity of ischemia.
  
  
  RESULTS
  We studied the outcome of 472 patients with multivessel CAD and prior revascularization (coronary angioplasty, 290 patients; bypass surgery, 182 patients), who underwent exercise or dipyridamole 99mTc-sestamibi MPS for evaluation of ischemia. Visual scoring of perfusion images used 20 segments and a 5-point scale. Gated post-stress EF was automatically calculated. Endpoints included hard events: cardiac death (CD) and nonfatal myocardial infarction (MI). During a mean follow-up of 3.0 ± 1.0 years, 37 hard events occurred, including CD in 15 (3%) and MI in 22 (5%) patients. In a risk-adjusted multivariable Cox model, a history of prior MI, diabetes, abnormal MPS, moderate-to-severe ischemia, and post-stress EF <35% were important predictors of cardiac events. Four-year risk-adjusted survival was 97.9% for normal MPS, 87.3% for abnormal MPS with ischemia, and 82.1% for moderate-to-severe ischemia.
  
  
  CONCLUSIONS
  Among patients with previous coronary revascularization, stress-gated 99mTc-sestamibi MPS provides prognostic information for the prediction of cardiac events. A normal perfusion scan confers an excellent prognosis and an exceedingly low hard event rate (<1%/year). The presence of moderate-to-severe ischemia or a post-stress EF <35% identifies patients at highest risk of subsequent cardiac events.
authors.affiliation: Clinic of Cardiology, Department of Internal Medicine, City Hospital Triemli, Zurich, Switzerland.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Schepis
authors.forename: Karin
authors.initials: K
authors.lastname: Benz
authors.forename: Andreas
authors.initials: A
authors.lastname: Haldemann
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
authors.forename: Christian
authors.initials: C
authors.lastname: Schmidhauser
authors.forename: Jürgen
authors.initials: J
authors.lastname: Frielingsdorf
mesh_terms: D000368:Aged; D017130:Angioplasty; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D003643:Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000473:pathology*; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization; D011379:Prognosis; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D012307:Risk Factors; D012737:Sex Factors; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi