title: Eleven-year prognostic value of dobutamine stress (99m)Tc-sestamibi myocardial perfusion imaging in patients with limited exercise capacity.
abstract: Myocardial perfusion single-photon emission computed tomography is a routine technique for the evaluation of coronary artery disease. However, information on the very long term prognostic value of dobutamine stress single-photon emission computed tomographic myocardial perfusion imaging (MPI) in patients with limited exercise capacity is scarce. The aim of this study was to assess the long-term prognostic value of dobutamine stress technetium-99m ((99m)Tc)-sestamibi MPI in these patients. The study population consisted of a high-risk cohort of 531 consecutive patients with limited exercise capacity who underwent dobutamine stress (99m)Tc-sestamibi MPI for the assessment of known or suspected coronary artery disease. Follow-up was successful in 528 patients. Because of early revascularization, 55 patients were excluded. The present data are based on 473 patients. The end points were all-cause mortality, cardiac death, nonfatal myocardial infarction, and late (>60 days) coronary revascularization. Kaplan-Meier survival curves were performed and univariate and multivariate analyses were performed to identify predictors of very long term outcome. The mean age of the patients was 61 ± 12 years, and 58% were men. Abnormal results (defined as the presence of reversible or fixed defects) were observed in 312 patients (66%). During a mean follow-up period of 11.3 ± 6.7 years, 287 patients (61%) died (all-cause mortality), of whom 125 (26%) died due to cardiac causes. Nonfatal myocardial infarction occurred in 59 patients (12%). Late coronary revascularization was performed in 61 patients (13%). Univariate predictors of major cardiac events included age, male gender, previous infarction, diabetes mellitus, history of angina, heart failure, ST-segment changes, abnormal results on (99m)Tc-sestamibi scan, reversible defect, fixed defect, summed rest score, and summed stress score. Multivariate analysis identified abnormal results on MPI as a strong independent predictor of major adverse cardiac events. In conclusion, in patients with limited exercise capacity, dobutamine stress (99m)Tc-sestamibi single-photon emission computed tomography provides incremental prognostic information in addition to clinical and stress test parameters for the prediction of very long term outcomes.
authors: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Hendrik J
authors: HJ
authors: Boiten
authors: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Ron T
authors: RT
authors: van Domburg
authors: Department of Nuclear Medicine, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Roelf
authors: R
authors: Valkema
authors: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: a.schinkel@erasmusmc.nl.
authors: Arend F L
authors: AF
authors: Schinkel
mesh_terms: D002316:Cardiotonic Agents; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D004280:Dobutamine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005080:Exercise Test / Q000379:methods; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi / Q000008:administration & dosage; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D002316:Cardiotonic Agents; D019275:Radiopharmaceuticals; D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi