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Updated: Jun 15, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Prognostic value of exercise myocardial scintigraphy in patients with coronary chronic total occlusions
Alfredo R Galassi1, Gerald S Werner, Salvatore D Tomasello
1Clinical Division of Cardiology, Department of Internal Medicine and Systemic Disease, Ferrarotto Hospital, University of Catania, Catania, Italy. argalassi@virgilio.it
Insights
Exercise myocardial perfusion imaging effectively predicts cardiac events in patients with untreated chronic total occlusions after percutaneous coronary intervention. This non-invasive test offers crucial prognostic information for guiding patient management.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Interventional Cardiology
Background:
- Incomplete revascularization after percutaneous coronary intervention (PCI) for multivessel disease may leave residual chronic total occlusions (CTOs).
- The prognostic implications of residual CTOs after PCI require further elucidation.
Purpose of the Study:
- To assess the prognostic value of exercise myocardial scintigraphy in patients with at least one untreated residual CTO post-PCI.
- To determine if myocardial perfusion imaging provides independent predictive information for cardiac events in this specific patient cohort.
Main Methods:
- Retrospective analysis of 569 patients with multivessel disease undergoing myocardial scintigraphy post-PCI.
- 126 patients with at least one residual CTO were included, with hard events (cardiac death, myocardial infarction) and soft events (unstable angina, repeat PCI) tracked over a median of 44 months.
- Prognostic value assessed using Kaplan-Meier analysis and Cox proportional-hazards models, incorporating scintigraphic variables alongside clinical and angiographic data.
Main Results:
- Six patients (4.8%) experienced hard events, all with severely abnormal perfusion defects on scintigraphy.
- Soft events occurred in 0%, 7.9%, and 11.9% of patients with normal, mildly abnormal, and severely abnormal perfusion, respectively.
- Myocardial scintigraphy variables significantly improved the prediction of composite cardiac events when added to clinical, angiographic, and functional parameters (P < 0.006).
Conclusions:
- Myocardial perfusion imaging offers significant independent prognostic information in patients with residual CTOs after PCI.
- Abnormal perfusion defects on scintigraphy are strongly associated with adverse cardiac events in this population.
- Exercise myocardial scintigraphy is a valuable tool for risk stratification in patients with incomplete revascularization and residual CTOs.
Objectives:
To evaluate the prognostic value of exercise myocardial scintigraphy in patients undergoing incomplete revascularization by means of percutaneous coronary intervention (PCI) with at least a residual chronic total occlusion (CTO) left untreated.
Methods:
Of 569 consecutive patients with multivessel disease undergoing myocardial scintigraphy after incomplete revascularization by PCI between March 1997 and December 2004, 126 (79% male, 64+/-10 years) with >or= 1 residual CTO fulfilled the eligibility criteria and entered in the study. Hard events defined as cardiac death and myocardial infarction, soft events defined as incidence of unstable angina and PCI procedures, and their composite were assessed at a median follow-up period of 44 months.
Results:
Hard events were observed in six patients (4.8%). All of them had severely abnormal perfusion defects detected by myocardial scintigraphy. Soft events occurred in 0 (0%), 10 (7.9%), and 15 (11.9%) patients with normal, mildly abnormal, and severely abnormal perfusion, respectively. In the Kaplan-Meier analysis, the log-rank test was statistically significant across patients stratified by summed stress score either in terms of hard, soft and hard, or soft events. Univariate and multivariate Cox proportional-hazards showed an incremental significant information when the scintigraphic variables were added to clinical, angiographic, left ventricular ejection fraction, and Duke treadmill score, for prediction of the composite of hard and soft cardiac events (P < 0.006).
Conclusions:
Among patients with a residual CTO left untreated after PCI, myocardial perfusion imaging provides significant independent information concerning the subsequent risk of cardiac events.
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