Author + information
- Received March 9, 2000
- Revision received June 28, 2000
- Accepted September 29, 2000
- Published online January 1, 2001.
- Hans-Marc J Siebelink, MD∗,* (, )
- Paul K Blanksma, MD, PhD∗,
- Harry J.G.M Crijns, MD, PhD∗,
- Jeroen J Bax, MD, PhD†,
- Ad J van Boven, MD, PhD∗,
- Tsjerk Kingma, MSc‡,
- D.Albertus Piers, MD, PhD§,
- Jan Pruim, MD, PhD∥,
- Piet L Jager, MD, PhD§,
- Willem Vaalburg, PhD∥ and
- Ernst E van der Wall, MD, PhD, FACC†
- ↵*Reprint requests and correspondence: Dr. Hans-Marc J. Siebelink, Thorax Center, Department of Cardiology, University Hospital Groningen, Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
We sought to prospectively compare nitrogen-13 (13N)-ammonia/18fluorodeoxyglucose (18FDG) positron emission tomography (PET)–guided management with stress/rest technetium-99m (99mTc)-sestamibi single-photon emission computed tomography (SPECT)–guided management.
Patients with evidence of jeopardized (i.e., ischemic or viable) myocardium may benefit from revascularization, whereas patients without it should be treated with drugs. Both PET and SPECT imaging have been proven to delineate jeopardized myocardium. When patient management is based on identification of jeopardized myocardium, it is unknown which technique is most accurate for long-term prognosis.
In a clinical setting, 103 patients considered for revascularization with left ventricular wall motion abnormalities and suspicion of jeopardized myocardium underwent both PET and SPECT imaging. The imaging results were used in a randomized fashion to determine management (percutaneous transluminal coronary angioplasty [PTCA], coronary artery bypass graft surgery [CABG] or drug treatment). Follow-up for cardiac events (cardiac death, myocardial infarction and revascularization) was recorded for 28 ± 1 months. The study was designed to have a power of 80% to detect a 20% difference in the event rate between PET- and SPECT-based management.
Management decisions in 49 patients randomized to PET (12 who had PTCA, 14 CABG and 23 drug therapy) were comparable with 54 patients randomized to SPECT (15 who had PTCA, 13 CABG and 26 drug therapy). In terms of cardiac event-free survival, no differences between PET and SPECT were observed (11 vs. 13 cardiac events for PET and SPECT, respectively; p = NS by the Kaplan-Meier statistic).
No difference in patient management or cardiac event-free survival was demonstrated between management based on 13N-ammonia/18FDG PET and that based on stress/rest 99mTc-sestamibi SPECT imaging. Both techniques may be used for management of patients considered for revascularization with suspicion of jeopardized myocardium.
☆ This study was financially supported by the Groningen University Hospital.
- Received March 9, 2000.
- Revision received June 28, 2000.
- Accepted September 29, 2000.
- American College of Cardiology