Document Detail

Comparison of late outcome in patients with versus without angina pectoris having reversible perfusion abnormalities during dobutamine stress technetium-99m sestamibi single-photon emission computed tomography.
MedLine Citation:
PMID:  12565080     Owner:  NLM     Status:  MEDLINE    
The aim of this study was to assess the prognostic significance of reversible perfusion abnormalities in patients without angina during dobutamine stress technetium-99m sestamibi single-photon emission computed tomography (SPECT). The study comprised 224 patients (age 60 +/- 11 years, 144 men) with completely or partially reversible perfusion abnormalities during dobutamine stress sestamibi SPECT. Follow-up end points were hard cardiac events (cardiac death and nonfatal myocardial infarction). Angina occurred in 93 patients (42%) during the dobutamine stress test (symptomatic ischemia group). The 131 patients without dobutamine-induced angina represented the silent ischemia group. There was no significant difference between patients with and without angina with regard to summed stress perfusion score (5.3 +/- 2.5 vs 5.2 +/- 2.2, p = 0.9) or summed ischemic score (3.1 +/- 1.7 vs 3.2 +/- 1.4, p = 0.7). During a median follow-up of 7.2 years, cardiac death occurred in 14 patients (15%) with and in 21 patients (16%) without angina. Nonfatal myocardial infarction occurred in 8 patients (9%) with and in 13 patients (10%) without angina. In a multivariate analysis model of clinical and perfusion data, independent predictors of cardiac events were age (hazard ratio 1.02, confidence intervals [CI] 1.01 to 1.05 per year increment), diabetes mellitus (hazard ratio 1.9, CI 1.2 to 3.4), and ischemic perfusion score (hazard ratio 2.1, CI 1.3 to 3.8). Patients with silent ischemia defined as reversible perfusion abnormalities without associated angina during dobutamine stress sestamibi SPECT imaging had similar incidences of ischemia and similar cardiac event rates compared with patients with symptomatic ischemia. Therefore, the absence of angina in association with reversible perfusion abnormalities should not be interpreted as a sign of a more benign prognosis.
Abdou Elhendy; Arend F L Schinkel; Ron T van Domburg; Jeroen J Bax; Don Poldermans
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  91     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-02-04     Completed Date:  2003-03-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  264-8     Citation Subset:  AIM; IM    
University of Nebraska Medical Center, Omaha, Nebraska 68198, USA.
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MeSH Terms
Angina Pectoris / diagnosis,  radionuclide imaging*
Dobutamine / diagnostic use
Exercise Test
Middle Aged
Myocardial Infarction / complications*
Tomography, Emission-Computed, Single-Photon*
Reg. No./Substance:

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