Prognostic value of stress Tc-99m tetrofosmin SPECT in patients with previous myocardial infarction: impact of scintigraphic extent of coronary artery disease.
Abdou Elhendy, Arend F L Schinkel, Ron T van Domburg, Jeroen J Bax, Roelf Valkema, Don Poldermans
Author Information
Abdou Elhendy: Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands. Aelhendy@unmc.edu
BACKGROUND: Our objective was to assess the prognostic value of the scintigraphic extent of coronary artery disease on stress technetium 99m tetrofosmin single photon emission computed tomography in patients with previous myocardial infarction. METHODS AND RESULTS: We studied 383 patients (280 men and 103 women; mean age, 60 +/- 11 years) more than 3 months after an acute myocardial infarction by exercise bicycle or dobutamine (up to 40 mug . kg -1 . min -1 ) stress Tc-99m tetrofosmin myocardial perfusion tomography. Stress images were acquired 1 hour after stress, and rest images were acquired 24 hours after stress testing. An abnormal study was defined as one demonstrating a reversible or fixed perfusion abnormality. Myocardial segments were assigned to corresponding coronary arteries as follows: the apex, anterior wall, and anterior septum were assigned to the left anterior descending coronary artery; the posterolateral wall was assigned to the left circumflex artery; and the basal posterior septum and inferior wall were assigned to the right coronary artery. During a mean follow-up of 4.3 +/- 2.1 years, 48 cardiac events occurred (36 cardiac deaths and 12 nonfatal myocardial infarctions). Myocardial perfusion was normal in 51 patients, abnormal in a single-vessel distribution in 170 patients, and abnormal in a multivessel distribution in 162 patients. The annual cardiac event rates in these groups were 0.4%, 2.6%, and 4%, respectively. In a multivariate analysis model, independent predictors of cardiac events were diabetes mellitus (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.4-4.5), history of congestive heart failure (OR, 2.7; 95% CI, 1.4-4), age (OR, 1.05; 95% CI, 1.01-1.08), and scintigraphic extent of coronary artery disease (OR, 4.2; 95% CI, 1.8-9.1). CONCLUSION: Stress Tc-99m tetrofosmin myocardial perfusion imaging provides independent prognostic information for the risk stratification of patients with previous myocardial infarction. The event rate is directly related to the scintigraphic extent of coronary artery disease. Patients with normal perfusion have an excellent event-free survival rate.
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