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Integrated SPECT/CT for assessment of haemodynamically significant coronary artery lesions in patients with acute coronary syndrome

  • Shmuel Rispler
  • Doron Aronson
  • Sobhi Abadi
  • Ariel Roguin
  • Ahuva Engel
  • Rafael Beyar
  • Ora Israel
  • Zohar Keidar
Original Article

Abstract

Purpose

Early risk stratification in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) is important since the benefit from more aggressive and costly treatment strategies is proportional to the risk of adverse clinical events. In the present study we assessed whether hybrid single photon emission computed tomography (SPECT)/coronary computed tomography angiography (CCTA) technology could be an appropriate tool in stratifying patients with NSTE-ACS.

Methods

SPECT/CCTA was performed in 90 consecutive patients with NSTE-ACS. The Thrombolysis in Myocardial Infarction risk score (TIMI-RS) was used to classify patients as low- or high-risk. Imaging was performed using SPECT/CCTA to identify haemodynamically significant lesions defined as >50% stenosis on CCTA with a reversible perfusion defect on SPECT in the corresponding territory.

Results

CCTA demonstrated at least one lesion with >50% stenosis in 35 of 40 high-risk patients (87%) as compared to 14 of 50 low-risk patients (35%; TIMI-RS <3; p <0.0001). Of the 40 high-risk and 50 (16%) low-risk TIMI-RS patients, 16 (40%) and 8 (16%), respectively, had haemodynamically significant lesions (p = 0.01). Patients defined as high-risk by a high TIMI-RS, a positive CCTA scan or both (n = 45) resulted in a sensitivity of 95%, specificity of 49%, PPV of 35% and NPV of 97% for having haemodynamically significant coronary lesions. Those with normal perfusion were spared revascularization procedures, regardless of their TIMI-RS.

Conclusion

Noninvasive assessment of coronary artery disease by SPECT/CCTA may play an important role in risk stratification of patients with NSTE-ACS by better identifying the subgroup requiring intervention.

Keywords

Myocardial perfusion imaging SPECT/CT Coronary artery disease CT coronary angiography 

Notes

Conflicts of interest

Ora Israel: advisor to GE Healthcare.

All other authors declare that they have no conflicts of interest.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Shmuel Rispler
    • 1
    • 2
  • Doron Aronson
    • 1
  • Sobhi Abadi
    • 3
  • Ariel Roguin
    • 1
  • Ahuva Engel
    • 3
  • Rafael Beyar
    • 1
  • Ora Israel
    • 2
  • Zohar Keidar
    • 2
  1. 1.Department of Cardiology, Rambam Health Care Campus and the B. Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
  2. 2.Department of Nuclear Medicine, Rambam Health Care Campus and the B. Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
  3. 3.Department of Medical Imaging, Rambam Health Care Campus and the B. Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael

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