Abstract
Dipyridamole (DIP) is the most commonly employed pharmacological stressor for myocardial perfusion tomography (SPECT) in patients unable to reach an adequate work load. To assess the predictive capacity of DIP SPECT on survival. We included 985 adults aged 66 ±11 years (45% women) with rest and DIP-SPECT. The main indications for the procedure were coronary artery disease (CAD) screening in 66% and known CAD in 33%. Participants were followed up for a median of 65 months (interquartile range 54 to 86 months). During the follow up, 261 deaths were recorded and 98% had a specified cause in their death certificate. Myocardial SPECT was abnormal in 44% of participants. Transient ischemic defects were observed in 34%, fixed defects concordant with infarction in 27% and post-stress systolic dysfunction in 23%. Twenty five percent of deaths were attributable to cardiac or ischemic cause and 22% to cancer. In a bivariate analysis, the hazard ratio (HR) of death of any cause was lower in females and higher in the presence of CAD. The multivariate analysis showed that being older than 46 years increased the HR of death of any cause. In a bivariate analysis, the HR for cardiac death was higher when the myocardial SPECT showed ischemia, necrosis or left ventricular dilation. In the multivariate analysis, post-stress left ventricular systolic function was associated with a lower risk of cardiac death. An abnormal myocardial SPECT, perfusion abnormalities, left ventricular systolic function or dilation are independent predictors of cardiac death in these participants.
Highlights
La enfermedad coronaria (EC) es uno de los problemas de salud pública más importantes, tanto a nivel internacional como nacional
Existen grupos de alto riesgo clínico, como los diabéticos, en quienes los eventos anuales aumentan hasta 2-3%, especialmente si presentan otros factores de riesgo cardiovascular (FRCV)[14]; así como aquellos que realizan estrés farmacológico, que se asocian a tasas anuales de 1-2%, en oposición a < 1% en estudios normales con ejercicio[15] por las condiciones basales inherentes a la indicación, que impiden la realización de una prueba adecuada y presentan peor sobrevida que aquellos con indicación de ejercicio, incluso sin considerar sus FRCV16,17
Alasbimn Journal 7 (26): October 2004 Article N° AJ26-3. 2004
Summary
Luis Alarcón[1], Matías Rau1,a, Hernán Prat[2], René Fernández1,b, Jaime Carmona1,b, Juan P. The HR for cardiac death was higher when the myocardial SPECT showed ischemia, necrosis or left ventricular dilation. Post-stress left ventricular systolic function was associated with a lower risk of cardiac death. Conclusions: An abnormal myocardial SPECT, perfusion abnormalities, left ventricular systolic function or dilation are independent predictors of cardiac death in these participants. Alarcón et al. Entre los principales estudios no invasivos para diagnosticar y estratificar riesgo en pacientes con EC conocida o sospechada está la tomografía por emisión de fotón único (SPECT) miocárdico, que permite determinar la presencia de isquemia, necrosis y tejido viable, dependiendo del tipo de defecto de perfusión y de la función ventricular[3,4]. El objetivo del presente estudio fue caracterizar nuestra población local, que efectúa IPM bajo efecto de estrés farmacológico con DIP y evaluar sobrevida a mediano plazo
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