Differential prognostic significance of peri-infarction versus remote myocardial ischemia on stress technetium-99m sestamibi tomography in patients with healed myocardial infarction
Section snippets
Patient selection
The study population consisted of 350 consecutive patients with a history of myocardial infarction of >1 month (mean 3.5 ± 2.2 years) who demonstrated a reversible perfusion abnormality on stress technetium-99m sestamibi myocardial perfusion tomography in our laboratory between 1992 and 1995. The choice of stress test was based on ability to exercise. Patients with limited exercise capacity underwent a dobutamine stress test. Follow-up was successful in 345 patients (99%). The data of these
Clinical data
Mean age was 59 ± 10 years. There were 282 men (82%). Symptoms before the stress test were typical angina in 131 patients (38%) and atypical chest pain in 102 patients (30%). Risk factors for coronary artery disease were hypercholesterolemia in 126 (37%), hypertension in 122 (35%), smoking in 110 (32%), and diabetes mellitus in 59 (17%). Fifty-three patients (15%) had a history of heart failure. The infarct-related artery was determined to be the left anterior descending in 135 patients (39%),
Discussion
Identification of stress test parameters associated with increased risk of future cardiac events is important for planning appropriate management strategies in patients with known or suspected coronary artery disease. Stress myocardial perfusion imaging is an effective tool for the diagnosis of peri-infarction and remote ischemia.1, 2, 3, 15 Although previous studies have associated reversible perfusion abnormalities with increased risk of cardiac events in patients with healed myocardial
References (21)
- et al.
Comparison of dobutamine stress echocardiography and 99m-technetium sestamibi SPECT myocardial perfusion scintigraphy for predicting extent of coronary artery disease in patients with healed myocardial infarction
Am J Cardiol
(1997) - et al.
Technetium-99m sestamibi tomographic evaluation of residual ischemia after anterior myocardial infarction
J Am Coll Cardiol
(1995) - et al.
Accuracy of exercise stress technetium 99m sestamibi SPECT imaging in the evaluation of the extent and location of coronary artery disease in patients with an earlier myocardial infarction
J Nucl Cardiol
(2000) - et al.
Risk stratification in patients with remote prior myocardial infarction using rest-stress myocardial perfusion SPECTprognostic value and impact on referral to early catheterization
J Nucl Cardiol
(2002) - et al.
Use of exercise technetium-99m sestamibi SPECT imaging to detect residual ischemia and for risk stratification after acute myocardial infarction
Am J Cardiol
(1995) - et al.
Residual exertional ischemia and unfavorable left ventricular remodeling in patients with systolic dysfunction after anterior myocardial infarction
J Am Coll Cardiol
(1995) - et al.
Usefulness of technetium-99m sestamibi infarct size in predicting posthospital mortality following acute myocardial infarction
Am J Cardiol
(1998) - et al.
Location of an acute myocardial infarct in patients with a healed myocardial infarctanalysis of 129 patients studied at necropsy
Am J Cardiol
(1988) - et al.
Relation between perfusion defects on stress technetium-99m sestamibi SPECT scintigraphy and the location of a subsequent acute myocardial infarction
Am J Cardiol
(1996) - et al.
Prognostic significance of fixed perfusion abnormalities on stress technetium-99m sestamibi single-photon emission computed tomography in patients without known coronary artery disease
Am J Cardiol
(2003)
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2010, Journal of Cardiovascular Magnetic ResonanceThe Prognostic Value of Normal Exercise Myocardial Perfusion Imaging and Exercise Echocardiography. A Meta-Analysis
2007, Journal of the American College of CardiologyCitation Excerpt :Among these, 148 full-text articles evaluating the prognostic utility of exercise MPI or exercise echocardiography were reviewed, and 20 studies were found to be eligible for the systematic review. Of the 148 full-text articles reviewed, 17 did not address the research question (15–31), 18 were excluded because they used pharmacologic rather than exercise stress (32–49), 27 did not include primary data on event rates that could be combined in a meta-analysis (47,50–75), 16 did not address a population with known or suspected CAD (76–91), 5 evaluated only hospitalized patients or patients evaluated for chest pain syndromes in the emergency department (92–96), 16 included only patients with angiographically proven CAD or positive tests (97–112), 21 were potentially overlapping patient populations of other studies (53,113–132), 5 evaluated planar MPI (133–137), and 3 did not define a negative test as one without any abnormalities (138–140). Of the 17 studies included that evaluated MPI (141–156), 5 used thallium (143,147,153,154,157), 8 used sestamibi (141,142,146,148–150,152,156), 2 used both thallium and sestamibi (145,155), and 2 used tetrofosmin (144,151).
The year in cardiac imaging
2005, Journal of the American College of CardiologyCitation Excerpt :Given these caveats, CT may prove to be less useful in the highest risk patients—the elderly, the unstable, the uncooperative—and may be most useful in a lower risk group. Elhendy et al. (47) demonstrated the prognostic significance of peri-infarction ischemia in 345 patients with previous MI. Peri-infarction ischemia was a surprisingly better prognostic indicator than remote ischemia.
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