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Published on: February 16, 2016
Incremental prognostic value of myocardial perfusion 99m-technetium-sestamibi SPECT in the elderly
Ronaldo S L Lima1, Andrea De Lorenzo, Mauricio R Pantoja
1Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. ronlima@hotmail.com
Insights
Technetium-99m sestamibi SPECT effectively predicts cardiac events in elderly patients with suspected coronary artery disease (CAD). An abnormal scan is a strong indicator of future cardiac events, guiding risk stratification.
Area of Science:
- Cardiology
- Nuclear Medicine
- Geriatric Medicine
Background:
- Coronary artery disease (CAD) is a leading cause of mortality in the elderly.
- Single-photon emission computed tomography (SPECT) is valuable for CAD diagnosis and risk stratification in the general population.
- The prognostic utility of SPECT in elderly individuals with suspected CAD remains underexplored.
Purpose of the Study:
- To evaluate the prognostic value of technetium-99m ((99m)Tc)-sestamibi SPECT for predicting cardiac outcomes in patients aged 74 and older with suspected CAD.
Main Methods:
- A cohort of 328 elderly patients (≥74 years) with suspected CAD underwent pharmacological or exercise stress (99m)Tc-sestamibi SPECT.
- Patients were followed for a mean of 34 months for hard events (myocardial infarction, cardiac death) or total events (myocardial infarction, cardiac death, revascularization).
- Statistical analysis, including multivariate analysis, was performed to assess the association between SPECT findings and cardiac events.
Main Results:
- Abnormal myocardial perfusion scintigraphy (MPS) was identified in 27.1% of patients.
- Abnormal SPECT findings were significantly associated with an increased risk of both hard and total cardiac events (P<0.0001).
- An abnormal scan emerged as the most potent independent predictor of cardiac events in multivariate analysis, with annual hard event rates of 14.3% for abnormal scans versus <1.0% for normal scans.
Conclusions:
- (99m)Tc-sestamibi SPECT is a powerful and independent predictor of cardiac events in elderly patients with suspected CAD.
- SPECT imaging provides crucial prognostic information for risk stratification and management decisions in this vulnerable population.
- The study establishes the prognostic value of SPECT for elderly individuals, addressing a gap in previous research.
Abstract:
Coronary artery disease (CAD) is the main cause of death in elderly patients. Single-photon emission computed tomography (SPECT) with technetium-99m ((99m)Tc)-labeled agents is extremely useful for the diagnosis and risk stratification of CAD in the general population. However, its prognostic value for the elderly has not been established. This study examined disease outcome in 328 patients aged 74 or older, with suspected CAD who were submitted to either pharmacological (dipyridamole) or exercise stress SPECT with (99m)Tc-sestamibi, seven of whom were completely lost to follow-up. Endpoints were defined as hard (myocardial infarction or cardiac death) or total events (myocardial infarction, cardiac death or myocardial revascularization). Mean follow-up was 34+/-15 months. During this period 24 cardiac deaths, 11 myocardial infarctions and 21 cases of revascularization were observed. Perfusion defects were found in 27.1% of patients (12.8% reversible, 6.2% partially reversible and 8.1% fixed). Abnormal studies were predominant in men, patients with chest pain and those with ST-T abnormalities in the baseline electrocardiogram (ECG) or in the exercise treadmill test. An abnormal scan was significantly associated with cardiac events (P<0.0001). Multivariate analysis revealed that a abnormal scan was the most important independent predictor of hard or total cardiac events. Event rates increased according to myocardial perfusion scintigraphy (MPS): <1.0% of hard events per year in patients with normal MPS versus 14.3% per year in those with abnormal MPS. (99m)Tc-sestamibi SPECT was demonstrated to be a powerful tool for the prognostic evaluation of elderly patients with suspected CAD.