Stress/rest myocardial perfusion scintigraphy in patients without significant coronary artery disease

Abstract

AimTo define the prognostic impact of stress myocardial perfusion scintigraphy (MPS) in patients with angiographic exclusion of significant coronary artery disease. MethodsAngiographic and MPS databases were matched to define patients without significant coronary artery disease by quantitative angiography (diameter stenosis <50%) who underwent stress MPS and coronary angiography within a time period of 3 months. A total of 118 patients were identified and followed for a mean of 6.3 ± 1.2 years for death, a composite of death, myocardial infarction, bypass surgery, or percutaneous coronary intervention [MAE]) as well as occurrence of symptoms (angina or dyspnoe class CCS II to IV). Stress and rest MPS (using 99mTc-MIBI or tetrofosmin) were analyzed by quantitative perfusion SPECT (QPS) for summed stress and rest scores (SSS/SRS). ResultsThere were 16 deaths, 29 MAE, and 76 patients with MAE or significant symptoms during follow-up. Significant differences in SSS were found between patients who died (9.5 ± 6.9 vs. 5.4 ± 5.6, P = 0.012), had MAE (8.7 ± 7.2 vs. 5.2 ± 5.0, P = 0.010), or had MAE or significant clinical symptoms (7.2 ± 7.1 vs. 4.6 ± 6.2, P = 0.042) compared to those without the respective event. Logistic regression analysis demonstrated SSS to be a predictor of death (OR = 1.074 [95% CI: 1.004-1.149], P = 0.026) and MAE (OR = 1.087 [95% CI: 1.004-1.181], P = 0.027). ConclusionsIn patients without significant angiographic coronary artery disease, the result of stress MPS is a predictor of long-term prognosis. Quantitative analysis of MPS allows definition of patients with a higher likelihood to develop clinical events or symptoms.