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The prognostic value of a normal Tc-99m sestamibi SPECT study in suspected coronary artery disease
1Department of Cardiovascular Medicine, Northwick Park & St. Marks Hospitals NHS Trust and Institute of Medical Research, Harrow, United Kingdom.
Insights
A normal stress technetium 99m-sestamibi SPECT scan is highly predictive of a benign outcome. This finding holds true even for patients with an intermediate probability of coronary artery disease (CAD).
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Myocardial perfusion imaging is crucial for risk stratifying patients with suspected or known coronary artery disease (CAD).
- Technetium 99m-sestamibi single-photon emission computed tomography (SPECT) has become a reliable nuclear cardiology screening tool.
- Large-scale data on the prognostic value of normal Tc 99m-sestamibi SPECT scans are limited.
Purpose of the Study:
- To assess the incidence of cardiac death and non-fatal myocardial infarction in patients with an intermediate probability of CAD.
- To evaluate the prognostic significance of a normal stress Tc 99m-sestamibi SPECT scan.
Main Methods:
- A cohort of 473 patients with normal stress Tc 99m-sestamibi SPECT underwent monitoring for serious cardiac events.
- Patient follow-up averaged 30 months (range, 6-56 months).
- Demographics included a mean age of 56 years, with 89% symptomatic for CAD and 65% having abnormal exercise ECGs.
Main Results:
- The annualized mortality rate in the study group was 0.2% (95% CI, 0.02% to 0.7%).
- No non-fatal myocardial infarctions were recorded in patients with normal scans.
Conclusions:
- A normal stress Tc 99m-sestamibi SPECT scan demonstrates a highly favorable prognosis.
- This benign outcome is observed even in patients presenting with an intermediate pre-test probability of coronary artery disease.
Background:
Myocardial perfusion is widely used for risk stratification of patients with suspected or known coronary artery disease (CAD). Recent years have seen an increasing demand for screening of such patients. The value of a normal stress thallium-201 scanning is well established. The advent of technetium 99m-sestamibi single photon emission computed tomography (SPECT) has enhanced the profile of nuclear cardiology even further as a reliable test for screening. However, in spite of previous reports, there is paucity of large-scale data regarding the prognostic value of a normal Tc 99m-sestamibi scanning result.
Methods:
The aim of our study was to assess the incidence of cardiac death and non-fatal myocardial infarction in patients with an intermediate probability of coronary artery disease (CAD). A total of 473 patients with normal stress Tc-99m-sestamibi SPECT were monitored for 30+/-16 (6 to 56) months to assess serious cardiac events. There were 272 men and 201 women, with a mean age of 56+/-2 years, of whom 89% had symptoms suggestive of CAD, 65% had an abnormal exercise electrocardiography, 6% had known CAD, and 5% had a high risk of CAD. The average workload was 9.14 metabolic equivalents, peak exercise heart rate was 93%+/-13% of the age predicted target.
Results:
The annualized mortality rate was 0.2% (95%CI 0.02% to 0.7%) and no infarctions occurred in this group.
Conclusions:
A normal stress Tc-99m-sestamibi is highly predictive of a benign outcome, even in patients with intermediate probability of CAD.