| Risk assessment using single-photon emission computed tomographic technetium-99m sestamibi imaging. | |
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MedLine Citation:
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PMID: 9669249 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: This review summarizes the results of single-photon emission computed tomographic (SPECT) technetium-99m (Tc-99m) tracer imaging in patients with stable symptoms, patients with acute coronary syndromes, patients undergoing major non-cardiac surgery and patients with chest pain in the emergency department. BACKGROUND: Previous studies have examined the prognostic value of stress thallium imaging in several subsets of patients with ischemic heart disease. At present, >50% of myocardial perfusion studies are performed with technetium-labeled tracers in the United States. Furthermore, there is a shift from diagnostic to the prognostic utility of stress testing. There are important differences between technetium-labeled tracers and thallium-201. It is therefore important to review the prognostic value of technetium-labeled tracers. METHODS: We analyzed published reports in English on risk assessment using Tc-99m perfusion tracers. Results. The largest experience is in patients with stable symptoms, comprising >12,000 patients in 14 studies. In these patients, normal stress SPECT sestamibi images were associated with an average annual hard event rate of 0.6% (death or nonfatal myocardial infarction [MI]). In contrast, patients with abnormal images had a 12-fold higher event rate (7.4% annually). Both fixed and reversible defects are prognostically important, and quantitative analysis shows increased risk in relation to the severity of the abnormality. These results are similar to those obtained with thallium-201. CONCLUSIONS: Patients with stable chest pain syndromes and normal stress SPECT sestamibi images have a very low risk of death or nonfatal MI. It is highly unlikely that coronary revascularization can improve survival in such patients. Patients with abnormal images have an intermediate to high risk for future cardiac events, depending on the degree of the abnormality. Further prospective studies comparing aggressive medical therapy with coronary revascularization in these patients are warranted. |
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Authors:
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S Iskander; A E Iskandrian |
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Publication Detail:
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Type: Comparative Study; Journal Article; Review |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 32 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1998 Jul |
Date Detail:
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Created Date: 1998-07-22 Completed Date: 1998-07-22 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 57-62 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, MCP-Hahnemann School of Medicine, Allegheny University of the Health Sciences, Philadelphia, Pennsylvania 19102, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cause of Death Chest Pain / etiology, mortality, radionuclide imaging Coronary Disease / mortality, radionuclide imaging* Emergency Service, Hospital Exercise Test Humans Myocardial Infarction / mortality, radionuclide imaging* Prognosis Risk Assessment Sensitivity and Specificity Survival Analysis Technetium Tc 99m Sestamibi / diagnostic use* Thallium Radioisotopes / diagnostic use Tomography, Emission-Computed, Single-Photon* |
| Chemical | |
Reg. No./Substance:
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0/Thallium Radioisotopes; 109581-73-9/Technetium Tc 99m Sestamibi |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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