Journal of Nuclear Cardiology

, Volume 20, Issue 5, pp 755–762

Prognostic value of stress-gated 99m-technetium SPECT myocardial perfusion imaging: Risk stratification of patients with multivessel coronary artery disease and prior coronary revascularization

  • Tiziano Schepis
  • Karin Benz
  • Andreas Haldemann
  • Philipp A. Kaufmann
  • Christian Schmidhauser
  • Jürgen Frielingsdorf
Original Article

DOI: 10.1007/s12350-013-9749-4

Cite this article as:
Schepis, T., Benz, K., Haldemann, A. et al. J. Nucl. Cardiol. (2013) 20: 755. doi:10.1007/s12350-013-9749-4

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.

Methods and 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.

Keywords

Myocardial perfusion imaging gated SPECT prognosis coronary artery disease prior coronary revascularization left ventricular function 

Copyright information

© American Society of Nuclear Cardiology 2013

Authors and Affiliations

  • Tiziano Schepis
    • 1
  • Karin Benz
    • 1
  • Andreas Haldemann
    • 2
  • Philipp A. Kaufmann
    • 3
  • Christian Schmidhauser
    • 4
  • Jürgen Frielingsdorf
    • 5
  1. 1.Clinic of Cardiology, Department of Internal MedicineCity Hospital TriemliZurichSwitzerland
  2. 2.Clinic of Nuclear MedicineCity Hospital TriemliZurichSwitzerland
  3. 3.Cardiovascular CenterUniversity Hospital ZurichZurichSwitzerland
  4. 4.La Volta StatisticsZurichSwitzerland
  5. 5.Division of Cardiology, Department of Internal MedicineCantonal Hospital WinterthurWinterthurSwitzerland