Document Detail


Long-term prognostic value of exercise 99mTc-MIBI SPET myocardial perfusion imaging in patients after percutaneous coronary intervention.
MedLine Citation:
PMID:  14740177     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The purpose of this study was to evaluate the long-term prognostic value of exercise technetium-99m methoxyisobutylisonitrile ((99m)Tc-MIBI) single-photon emission tomography (SPET) imaging in patients after percutaneous coronary intervention (PCI). Three hundred and eighteen consecutive post-PCI patients who underwent exercise and rest (99m)Tc-MIBI SPET myocardial perfusion imaging (MPI) were followed up for 38+/-27 months. Patients with early revascularisation (<3 months after MPI) were excluded. A semiquantitative visual analysis employing a 20-segment and four-point scoring system was used to define the summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS). Death and non-fatal myocardial infarction (MI) were considered as hard events, and late revascularisation procedures (>/=3 months after MPI) as soft events. Fifty-one patients (16.0%) suffered from cardiac events during follow-up, including 1 (0.3%) death, 13 (4.1%) non-fatal MIs, 9 (2.8%) coronary artery bypass grafting procedures and 28 (8.8%) PCIs. According to the SPET results, patients were classified into three groups: patients with normal MPI (SSS=0, n=153), patients with irreversible defects (SDS<3 and SRS>1, n=100) and patients with reversible defects (SDS>/=3, n=65). The annual hard cardiac event rate in patients with reversible defects was 3.9%, which was significantly higher than that in patients with normal MPI (0.2%, chi(2)=7.71; P<0.01). The annual soft cardiac event rate in patients with reversible defects was 10.7%, which was significantly higher than that in patients with irreversible defects (2.5% chi(2)=17.69; P<0.001), and also significantly higher than that in patients with normal MPI (1.5%, chi(2)=33.89; P<0.001). In patients with normal and reversible defects, there was no significant difference in soft and hard cardiac event rates according to whether patients were symptomatic or asymptomatic ( P>0.05). However, the annual soft event rate in patients with irreversible defects and symptoms was 5.0%, which was higher than that of 0.6% in asymptomatic patients (chi(2)=6.11, P<0.05). Multivariate Cox analysis showed that SSS was the best independent predictor for hard cardiac events (chi(2)=12.70; P<0.001) and SDS was the strongest independent predictor for soft cardiac events (chi(2)=11.72; P<0.001). Post-PCI patients who have normal exercise (99m)Tc-MIBI SPET MPI have a good long-term prognosis, while those with reversible defects are at a higher risk for future cardiac events, without correlation to the chest pain symptoms. However, symptomatic patients with irreversible defects have a higher risk for repeat revascularisation, but not for hard events, compared with asymptomatic patients. Exercise (99m)Tc-MIBI SPET MPI has important clinical value for risk stratification and management decision-making in post-PCI patients.
Authors:
Xiaoli Zhang; Xiujie Liu; Zuo-Xiang He; Rongfang Shi; Minfu Yang; Runlin Gao; Jilin Chen; Yuejin Yang; Wei Fang
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article; Validation Studies     Date:  2004-01-22
Journal Detail:
Title:  European journal of nuclear medicine and molecular imaging     Volume:  31     ISSN:  1619-7070     ISO Abbreviation:  Eur. J. Nucl. Med. Mol. Imaging     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-04-19     Completed Date:  2004-12-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  101140988     Medline TA:  Eur J Nucl Med Mol Imaging     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  655-62     Citation Subset:  IM    
Affiliation:
Cardiovascular Institute and Fu Wai Hospital, PUMC & CAMS, A 167 Beilishilu, 100037 Beijing, China.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary / statistics & numerical data*
China / epidemiology
Coronary Artery Disease / epidemiology,  radionuclide imaging*,  surgery*
Disease-Free Survival
Exercise Test
Female
Heart / radionuclide imaging*
Humans
Longitudinal Studies
Male
Middle Aged
Prognosis
Radiopharmaceuticals / diagnostic use
Risk Assessment / methods*
Risk Factors
Technetium Tc 99m Sestamibi / diagnostic use*
Time Factors
Tomography, Emission-Computed, Single-Photon / statistics & numerical data*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi

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