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Published on: January 28, 2020
A negative myocardial perfusion scintigram after coronary angioplasty confers benign long-term prognosis
Rui Campante Teles1, K Reis-Santos, Victor Gil
1Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal. arteles@clix.pt
Insights
Patients with no or mild ischemia after coronary angioplasty have an excellent prognosis. Even mild persistent defects on SPECT scans indicate a good long-term outlook, with low rates of major adverse cardiac events.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Myocardial perfusion SPECT is utilized to detect restenosis or disease progression post-percutaneous coronary angioplasty (PTCA).
- Limited research exists on the prognostic implications of negative SPECT findings after successful PTCA.
Purpose of the Study:
- To evaluate the long-term prognostic value of non-ischemic SPECT results following successful PTCA.
- To assess the outcomes of patients with varying degrees of ischemia after PTCA.
Main Methods:
- Retrospective analysis of 783 patients who underwent SPECT 3 months to 3 years after successful PTCA.
- Patients were categorized into groups based on SPECT findings: mild/no ischemia (Group A) vs. non-reversible defects (Group B).
- Primary endpoint included death, myocardial infarction (MI), unstable angina (UA), and repeat revascularization.
Main Results:
- Two-year event-free survival was 97.1% for Group A and 91.7% for Group B (p=0.16).
- Minimal differences in outcomes were observed between patients with mild/no ischemia and those with mild persistent defects.
- Low rates of MI, UA, and repeat PTCAs were recorded in both groups.
Conclusions:
- SPECT assessment >3 months post-PTCA identifies patients with an excellent prognosis if no or mild ischemia is present.
- Mild persistent defects on SPECT do not significantly worsen the long-term outcome for patients after successful PTCA.
Background:
Myocardial perfusion SPECT is often used to exclude late restenosis or disease progression after coronary angioplasty (PTCA), but few studies have been published regarding the prognostic value of a negative study.
Aim:
To examine the long-term prognostic value of a non-ischemic SPECT result after successful PTCA.
Methods:
We retrospectively reviewed 783 patients (pts) who underwent scintigraphy 3 months to 3 years after successful PTCA. In 118 no significant myocardial ischemia (moderate or severe) was observed. There was a history of myocardial infarction (MI) in 38.1%, multivessel disease in 36.8% and LVEF < 50% in 15.3%. Referral for SPECT was chronic angina in 50.5% and acute coronary syndrome in 32.2%. SPECT was performed using a treadmill exercise test in 72%, adenosine in 21%, dipyridamole in 3% and dobutamine in 4%. Fifty-three percent of pts were under anti-ischemic medication. Patients were divided into two groups according to the SPECT result: group A pts (n = 70) had mild or no ischemia and group B pts (n = 48) had non-reversible defects of small or moderate size. The endpoint was the combined occurrence of death, MI, unstable angina (UA) and repeated revascularization.
Results:
There were one MI, 2 UA episodes and 4 repeated PTCAs (1 for UA). Event-free survival rate at two-year follow-up was slightly lower in patients from group B compared with group A, respectively 91.7% versus 97.1% (p = 0.16, log rank test).
Conclusions:
This study suggests an excellent prognosis for patients with no or mild ischemia as assessed by SPECT performed more than 3 months after coronary angioplasty. Those patients with mild persistent defects did not present a significantly worse outcome.
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