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Effect of changes in perfusion defect size during serial stress myocardial perfusion imaging on cardiovascular outcomes in patients treated with primary percutaneous coronary intervention after myocardial infarction

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

We evaluated the prognostic value of changes in perfusion defect size (PDS) on serial MPS in patients treated with primary percutaneous coronary intervention (PCI) after acute myocardial infarction (AMI).

Methods

We enrolled 112 patients treated with primary PCI after AMI who underwent two stress MPS within 1 month and after 6 months. Improvement in PDS was defined as a reduction ≥5%. Remodeling was defined as an increase in left ventricular (LV) end-diastolic volume index ≥20%. Cardiac events included cardiac death, nonfatal MI, unstable angina, repeated revascularization, and heart failure.

Results

During a median follow-up of 86 months, 22 events occurred. Event rate was higher (P < .01) in patients with worsening of PDS compared to those with unchanged or improved PDS. Moreover, patients with remodeling had a higher (P < .001) event rate compared to those without. At Cox analysis, worsening of PDS and remodeling resulted independent predictors of events (both P < .01). Patients with both worsening of PDS and remodeling had the worst event-free survival (P <.001).

Conclusion

In patients treated with primary PCI after AMI, worsening of PDS and remodeling are associated to higher risk of events at long-term follow-up. Gated stress MPS improves risk stratification in these patients.

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Abbreviations

AMI:

Acute myocardial infarction

PCI:

Percutaneous coronary intervention

MPS:

Single-photon emission computed tomography myocardial perfusion imaging

LV:

Left ventricular

PDS:

Perfusion defect size

EDV:

End-diastolic volume

ESV:

End-systolic volume

EF:

Ejection fraction

AER:

Annual event rate

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Disclosure

Emilia Zampella, Teresa Mannarino, Valeria Gaudieri, Adriana D’Antonio, Francesco Giallauria, Roberta Assante, Valeria Cantoni, Roberta Green, Ciro Gabriele Mainolfi, Carmela Nappi, Andrea Genova, Mario Petretta, Alberto Cuocolo, and Wanda Acampa declare that they have no financial conflict of interest.

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Authors and Affiliations

  1. Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy

    Emilia Zampella MD, PhD, Teresa Mannarino MD, PhD, Valeria Gaudieri MD, PhD, Adriana D’Antonio MD, Roberta Assante MD, PhD, Valeria Cantoni PhD, Roberta Green PhD, Ciro Gabriele Mainolfi MD, Carmela Nappi MD, PhD, Andrea Genova MD, Alberto Cuocolo MD & Wanda Acampa MD, PhD

  2. Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy

    Francesco Giallauria MD

  3. Department of Diagnostic Imaging, IRCCS SDN, Naples, Italy

    Mario Petretta MD

  4. Institute of Biostructures and Bioimaging, CNR, Naples, Italy

    Wanda Acampa MD, PhD

Authors
  1. Emilia Zampella MD, PhD
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  2. Teresa Mannarino MD, PhD
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  3. Valeria Gaudieri MD, PhD
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  4. Adriana D’Antonio MD
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  6. Roberta Assante MD, PhD
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  7. Valeria Cantoni PhD
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  8. Roberta Green PhD
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  9. Ciro Gabriele Mainolfi MD
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  10. Carmela Nappi MD, PhD
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  11. Andrea Genova MD
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  12. Mario Petretta MD
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  13. Alberto Cuocolo MD
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  14. Wanda Acampa MD, PhD
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Corresponding author

Correspondence to Wanda Acampa MD, PhD.

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Zampella, E., Mannarino, T., Gaudieri, V. et al. Effect of changes in perfusion defect size during serial stress myocardial perfusion imaging on cardiovascular outcomes in patients treated with primary percutaneous coronary intervention after myocardial infarction. J. Nucl. Cardiol. 29, 2624–2632 (2022). https://doi.org/10.1007/s12350-021-02770-z

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