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Higher event rate in patients with known CAD despite a normal myocardial perfusion scan

Maseeh Uz Zaman1, Nosheen Fatima1, Unaiza Zaman1

  • 11 Department of Radiology, The Aga Khan University Hospital (AKUH), Karachi, Pakistan ; 2 Department of Nuclear Cardiology, Karachi Institute of Heart Diseases (KIHD), Karachi, Pakistan ; 3 Department of Nuclear Medicine, Dr Ziauddin Medical University, Karachi, Pakistan ; 4 MBBS Students, Dow University of Health Sciences (DUHS), Karachi, Pakistan.

Cardiovascular Diagnosis and Therapy
|July 11, 2014
PubMed

Insights

Even with normal stress SPECT MPI, patients with known coronary artery disease (CAD) face significant cardiac events. Smoking, heart failure, and poor heart rate response predict mortality, while diabetes and dyslipidemia predict non-fatal events.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Diagnostic Imaging

Background:

  • Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has a high negative predictive value.
  • The prognostic significance of normal SPECT MPI in patients with known coronary artery disease (CAD) requires further clarification.

Purpose of the Study:

  • To assess the cardiac event rate in patients with established CAD who exhibit normal stress SPECT MPI results.
  • To identify predictors of cardiac events in this patient cohort.

Main Methods:

  • A prospective study included 428 patients with a history of CAD.
  • Patients underwent stress and rest Tc-99m-MIBI SPECT MPI.
  • Follow-up was conducted for 2-5 years to record all-cause and cardiac mortality, and non-fatal myocardial infarction (MI).

Main Results:

  • The annualized rates for cardiac mortality and non-fatal MI were 2% and 3.6%, respectively.
  • Predictors for all-cause and cardiac mortality included smoking, congestive heart failure (CHF), and failure to achieve 85% of age-predicted heart rate.
  • Predictors for non-fatal MI included diabetes, dyslipidemia, smoking, and limited functional capacity (<7 METS).

Conclusions:

  • Patients with known CAD experience elevated cardiac event rates even with normal stress SPECT MPI.
  • Diabetes, dyslipidemia, smoking, and limited functional capacity are key predictors of cardiac events.
  • A cost-effective surveillance strategy is recommended for these patients.
Abstract

Keywords:
Myocardial perfusion imaging (MPI)coronary artery disease (CAD)event rateprognosis

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