The Prognostic Value and Clinical Use of Myocardial Perfusion Scintigraphy in Asymptomatic Patients after Percutaneous Coronary Intervention

Abstract

BackgroundThe role of myocardial perfusion scintigraphy (MPS) in the follow-up of asymptomatic patients after percutaneous coronary intervention (PCI) is not established.ObjectivesTo evaluate the prognostic value and clinical use of MPS in asymptomatic patients after PCI.MethodsPatients who underwent MPS consecutively between 2008 and 2012 after PCI were selected. The MPS were classified as normal and abnormal, the perfusion scores, summed stress score (SSS), and summed difference score (SDS) were calculated and converted into percentage of total perfusion defect and ischemic defect. The follow-up was undertaken through telephone interviews and consultation with the Mortality Information System. Primary endpoints were death, cardiovascular death, and nonfatal acute myocardial infarction (AMI), and secondary endpoint was revascularization. Logistic regression and COX method were used to identify the predictors of events, and the value of p < 0.05 was considered statistically significant.ResultsA total of 647 patients were followed for 5.2 ± 1.6 years. 47% of MPS were normal, 30% were abnormal with ischemia, and 23% were abnormal without ischemia. There were 61 deaths, 27 being cardiovascular, 19 non-fatal AMI, and 139 revascularizations. The annual death rate was higher in those with abnormal perfusion without ischemia compared to the groups with ischemia and normal perfusion (3.3% × 2% × 1.2%, p = 0.021). The annual revascularization rate was 10.3% in the ischemia group, 3.7% in those with normal MPS, and 3% in those with abnormal MPS without ischemia. The independent predictors of mortality and revascularization were, respectively, total perfusion defect greater than 6%, and ischemic defect greater than 3%. Forty-two percent of the patients underwent MPS less than 2 years after PCI, and no significant differences were observed in relation to those who underwent it after that period.ConclusionAlthough this information is not contemplated in guidelines, in this study MPS was able to predict events in asymptomatic after PCI patients, regardless of when they were performed.

Relationship between the Castelli risk indeces and the presence and severity of ischemia in non-geriatric patients with suspected coronary artery disease

“…In a study conducted with non-ST-segment elevation myocardial infarction patients, it was reported that there was a low correlation between CAD severity and CRI-I, but CRI-II did not show a significant relationship [19]. On the other hand, previous studies have reported a positive correlation between the myocardial damage and extent of CAD [20][21][22]. In the current study, CRI levels were higher in patients with ischemia.…”

Imagem Cardiovascular em Pacientes com COVID-19

“…Em resumo, a medicina nuclear é fundamental para o manejo de doenças cardiovasculares. [7][8][9][10][11] na cardiologia clínica de rotina, mas não é a primeira linha de abordagem para pacientes com COVID-19. Apesar disso, seus procedimentos podem eventualmente ajudar no manejo desses pacientes.…”

Análise crítica dos critérios de uso apropriado da cintilografia de perfusão miocárdica na investigação não invasiva de isquemia em pacientes assintomáticos de alto risco cardiovascular

“…Um outro estudo brasileiro 43 Considerando-se os AUC publicados em 2009, que contam com um critério especifico para suspeita de revascularização incompleta além dos critérios relacionados ao tempo para realização do exame após ICP, consideramos que pacientes com suspeita de revascularização incompleta não deveriam ser avaliados conjuntamente com os demais pacientes assintomáticos no cenário pós ICP, pois é bem estabelecido o papel da CPM no cenário de suspeita de revascularização incompleta. Em nosso estudo tivemos vários pacientes em que após a revascularização de um vaso com obstrução importante havia dúvida quanto à necessidade ou não de revascularização de obstruções duvidosas, e tais pacientes foram classificados segundo o critério 56, referente a suspeita de revascularização incompleta e não segundo os critérios 59 e 60, referentes ao tempo desde a ICP.…”