Independent prognostic value of intravenous dipyridamole with technetium-99m sestamibi tomographic imaging in predicting cardiac events and cardiac-related hospital admissions

Abstract

Patients with normal study results or a small defect after intravenous dipyridamole Tc-99m sestamibi SPECT imaging had an excellent short-term prognosis. Those with abnormal results (reversible or large defect) had an increased risk of subsequent cardiac death, nonfatal myocardial infarction and other cardiac-related hospital admissions.

Prognóstico em médio prazo da cintilografia de perfusão miocárdica de estresse na unidade de dor torácica

“…We found a rate of primary outcome of 1.71% within one year for the patients with altered scintigraphy, as compared with 6.04% for patients with normal tests. Our results, although they present only a trend towards statistical significance (p=0.086) for the occurrence of primary outcome are in accordance with the literature 19,31,[37][38][39] (Chart 1).…”

The prognostic signifi cance of normal technetium-99m MIBI myocardial perfusion spect imaging over a four-year follow-up period

“…(32)(33)(34)(35)(36) These reports all confi rmed the benign outcome in patients with a normal MIBI study over this follow-up period. Recently published reports have also demonstrated a good prognosis over even longer follow-up periods.…”

“…(5,6) The prognostic signifi cance of a normal stress-redistribution Tl-201 myocardial perfusion study in patients with known or suspected CAD is well documented, showing a benign outcome in such patients over the short-and long-term, with an overall cardiac event rate of less than 1% per year. (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) Previous studies have evaluated the prognostic value of a normal Tc-99m MIBI stress study over a period of 6-16 months using planar imaging, (32) over one year using single photon emission computed tomography (SPECT) or planar imaging, (33) over 19.6 months using dual isotope Tl-201 (rest) and Tc-99m MIBI (exercise) SPECT, (34) after dipyridamole Tc-99m sestamibi imaging (35) and over 22 ± 13 months after dobutamine-atropine stress. (36) All these studies confi rmed a benign short-term outcome in these patients with an overall cardiac event rate of less than 1% per year.…”

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

“…(56) When an MPI is found to be abnormal, the risk for hard events is related to the severity of the abnormality; the greater the affected area, the higher the risk. (51,(57)(58)(59)(60)(61)(62)(63)(64)(65)(66) Hachamovitch et al found that patients with a mildly abnormal scan were at intermediate risk for myocardial infarction (2.7%) but low risk for cardiac death (0.8%). (60) If the patients had to undergo pharmacological testing for any reason, or are elderly, have previous history of CAD, diabetes mellitus or atrial fi brillation, even with a mildly abnormal scan, the risk is increased.…”

“…(70,71) Fixed and reversible stress perfusion defects predict hard events; still, patients with extensive stress-induced defects are the ones at higher risk. (57)(58)(59)(60)62,63,65,(71)(72)(73) Perfusion defects are not the only determinants of risk. When MPI is performed with 201-Tl, abnormally increased tracer uptake of the FIGURE 1: Stress-rest MPI studies showing severe apical, apical-anterior, midanterior, mid-anteroseptal and basal-anteroseptal segments, stress induced ischemia (Short axis, vertical long axis and horizontal long axis views.…”