Does myocardial perfusion scintigraphy predict improvement in symptoms and exercise capacity following successful elective percutaneous coronary intervention?

Abstract

BackgroundElective percutaneous coronary intervention (PCI) without inducible ischaemia may not be beneficial. We investigated the prevalence of inducible hypoperfusion using myocardial perfusion scintigraphy (MPS) in patients undergoing PCI, and its ability to predict functional outcome. Methods and ResultsOne hundred and twenty-three patients listed for elective PCI underwent MPS, using treadmill exercise where possible. Seventy-seven patients (63%) described chest pain in daily life. Seventy-four of 103 (72%) exercise ECG tests were positive. Ninety-one (74%) had inducible hypoperfusion on MPS (extensive in 25; 20%). Interventionalists were blinded to the scintigraphic results, and PCI was performed as planned. Six months later, Seattle Angina Questionnaire physical limitation score had improved from 66 to 76 (P < 0.0001), and peak treadmill workload from 7.2 ± 2.3 to 9.0 ± 2.7 METS (P < 0.0001). Sex, limiting chest pain on baseline exercise testing, and MPS summed difference score (SDS) were independent predictors of improvement. Patients with both limiting chest pain and SDS ≥ 7 demonstrated an increase of 3.3 ± 1.8 METS, compared with ≈1.5 METS for other subgroups (P < 0.05). ConclusionsMany patients undergoing elective PCI in a UK centre have little or no evidence of inducible hypoperfusion. The combination of limiting chest pain during exercise testing and significant inducible hypoperfusion on MPS predicts a large increase in exercise capacity after PCI.