Long-term prognosis after a normal exercise stress Tc-99m sestamibi SPECT study

Area of Science:

• Cardiology
• Nuclear Cardiology
• Diagnostic Imaging

Background:

• Intermediate-term outcomes after normal stress technetium 99m sestamibi studies are favorable.
• Long-term survival data following these studies remain largely unexamined.
• This study investigates long-term mortality and cardiac events after normal stress sestamibi imaging.

Purpose of the Study:

• To evaluate the incidence of mortality and hard cardiac events.
• To identify predictors of long-term mortality and cardiac events.
• To assess the long-term prognostic value of a normal exercise stress sestamibi study.

Main Methods:

• 218 patients with normal myocardial perfusion on rest and stress Tc-99m sestamibi SPECT were studied.
• Follow-up duration averaged 7.4 +/- 1.8 years.
• Endpoints included all-cause mortality and hard cardiac events (cardiac death, nonfatal myocardial infarction).

Main Results:

• The annual mortality rate was 0.6% in the first 5 years, increasing to 1.8% between years 6-8.
• The annual hard cardiac event rate was 0.7% in the first 5 years, increasing to 1.5% between years 6-8.
• Independent predictors of cardiac events included prior coronary artery disease and lower exercise heart rate (<130 bpm).
• Age and lower exercise heart rate (<130 bpm) predicted all-cause mortality.

Conclusions:

• The annual mortality and cardiac event rates are less than 1% within 5 years post-normal exercise sestamibi study.
• Repeat testing is generally unnecessary unless symptoms change.
• Patients with a history of coronary artery disease or exercise heart rate <130 bpm require closer follow-up.