Author + information
- Received September 12, 1995
- Revision received March 14, 1996
- Accepted March 27, 1996
- Published online August 1, 1996.
- Marcel L. Geleijnse, MD,
- Abdou Elhendy, MD, PhD,
- Ron T. van Domburg, MSc,
- Jan H. Cornel, MD,
- Ambroos E.M. Reijs, MSc,
- Jos R.T.C. Roelandt, MD, PhD, FACC,
- Eric P. Krenning, MD, PhD and
- Paolo M. Floretti, MD, PhD, FACC*
- ↵*Address for correspondence: Dr. Paolo M. Fioretti, Thoraxcentre, Ba 302, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Objectives. This study investigated the prognostic value of dobutamine-atropine technetium-99m (Tc-99m) sestamibi singlephoton emission computed tomographic (SPECT) myocardial perfusion imaging.
Background. Dobutamine-atropine Tc-99m sestamibi SPECT imaging is an accurate method for the detection of coronary disease. However, the prognostic value of this stress modality has not been assessed.
Methods. Three hundred ninety-two consecutive patients with chest pain (mean [±SD] age 60 ± 12 years; 220 men, 190 with a previous myocardial infarction) underwent a dobutamineatropine Tc-99m sestamibi SPECT scintigraphic study. Patients were followed up for 22 ± 13 months to determine the univariate and multivariate variables associated with hard cardiac events (cardiac death, nonfatal myocardial infarction), to define their event-free survival and to determine whether the extent and severity of reversible perfusion defects correlated with events.
Results. Forty-four patients (11%) had hard cardiac events. Multivariate models demonstrated that older age (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.0 to 4.4), history of heart failure (OR 2.6, 95% CI 1.3 to 5.2), abnormal sestamibi scan results (OR 10.0, 95% CI 2.3 to 43.0) and reversible perfusion defects (OR 3.2, 95% CI 1.6 to 6.4) had independent predictive value. Patients without perfusion defects, with fixed defects alone, reversible defects alone and fixed plus reversible defects had annual hard cardiac event rates of 0.8%, 6.8%, 8.1% and 11.6%, respectively. Patients with increasing reversible defect scores had increasing annual event rates of 2.1%, 5.0%, 5.5%, 13.0% and 14.6%, respectively.
Conclusions. Dobutamine-atropine stress Tc-99m sestamibi SPECT imaging provides excellent prognostic information. The single most important independent predictor for future hard cardiac events is an abnormal pattern, and a reversible defect provides additional, independent prognostic information. Moreover, the extent and severity of reversible defects are major determinants for prognosis.
This study was supported in part by funds from the Dutch Heart Foundation, The Hague, The Netherlands (Grant NHS 94.135) and Cairo University Hospital, Cairo, Egypt, and was presented in part at the 43rd Annual Scientific Session of the American College of Cardiology, Orlando, Florida, March 1996.
- Received September 12, 1995.
- Revision received March 14, 1996.
- Accepted March 27, 1996.
- American College of Cardiology