Incremental value of myocardial perfusion scintigraphy in prognosis and outcomes of patients with coronary artery disease

Current Opinion in Cardiology

Volumn 11, Issue 6, 1996, Pages 613-620

  Bateman, Timothy M ^a   O'Keefe Jr , James H ^a   Williams, Milton E ^a  

^a Cardiovascular Consultants Inc   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CORONARY ARTERY BYPASS GRAFT; CORONARY ARTERY DISEASE; COST CONTROL; HEALTH CARE COST; HEART INFARCTION; HEART MUSCLE BLOOD FLOW; HEART SCINTISCANNING; HUMAN; PRIORITY JOURNAL; PROGNOSIS; REVIEW; TRANSLUMINAL CORONARY ANGIOPLASTY; TREADMILL EXERCISE; UNSTABLE ANGINA PECTORIS;

EID: 0029822628     PISSN: 02684705     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001573-199611000-00010     Document Type: Review

References (48)

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19. Machecourt J, Longere P, Fagret D, Vanzetto C, Wolf JE, Polidori C, Comet M, Denis B: Prognostic value of thallium-201 single-photon emission computed tomographic myocardial perfusion Imaging according to extent of myocardial defect: study in 1,926 patients with follow-up at 33 months. J Am Coll Cardiol 1994, 23:1096-1106.
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22. Iskandrian AS, Chae SC, Heo J, Stanberry CD, Wasserleben V, Cave V: Independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in coronary artery disease. J Am Coll Cardiol 1993, 22:665-670.
23. Stratmann HG, Williams GA, Wittry MD, Chaitman BR, Miller DD: Exercise technetium-99m sestamlbl tomography for cardiac risk stratification of patients with stable chest pain. Circulation 1994, 89:615-622.
24. 99mTc-sestamibi that normal or equivocal images are associated with a benign prognosis, even in patients with a high likelihood of CAD. Although incremental prognostic value was added by nuclear testing in all patient subgroups, a testing strategy that incorporated nuclear results was cost effective only in those groups with an intermediate to high likelihood of CAD before scanning.
25. Brown KA, Altland E, Rowen M: Prognostic value of normal technetium-99m-sestamibi cardiac imaging. J Nucl Med 1994, 35:554-557.
26. Palmas W, Friedman JD, Diamond CA, Silber H, Kiat H, Berman DS: Incremental value of simultaneous assessment of myocardial function and perfusion with technetium-99m sestamlbl for prediction of extent of coronary artery disaease. J Am Coll Cardiol 1995, 25:1024-1031. In this study of 70 patients who had coronary angiography within 6 months of SPECT sestamibi testing with treadmill exercise, the incremental value of SPECT findings over treadmill findings was established for prediction of CAD extent. First-pass radionuclide angiography at peak exercise added slightly to the prediction.
27. Brown KA: Prognostic value of cardiac imaging in patients with known or suspected coronary artery disease: comparison of myocardial perfusion imaging, stress echocardiography, and positron emission tomography. Am J Cardiol 1995, 75S(suppl):35D-41D. An excellent review of the comparative prognostic value of various types of noninvasive imaging, along with a consideration of studies demonstrating incremental value.
28. Berman DS, Kiat H, Friedman JD, Diamond G: Clinical applications of exercise nuclear cardiology studies in the era of healthcare reform. Am J Cardiol 1995, 75:3D-13D. A comprehensive review of current literature pertinent to situations in which there has been demonstrated to be incremental information by scintigraphy over information available without performing the test. Subcategories considered include those with no known CAD, and those who have had infarction, poor left ventricular function, unstable angina, PTCA, CABG, and several others.
29. O'Keefe Jr, Barnhart CS, Bateman TM: Comparison of stress echocardiography and stress myocardial perfusion scintigraphy for diagnosing coronary artery disease and assessing Its severity. Am J Cardiol 1995, 75:25D-34D.
30. Brown KA, Rowen M: Prognostic value of a normal exercise myocardial perfusion study in patients with angiographically significant coronary artery disease. Am J Cardiol 1993, 71:865-867.
31. Pancholy SB, Fattah AA, Kamal AM, Ghods M, Heo J, Iskandrian AS: Independent and Incremental prognostic value of exercise thallium single-photon emission computed tomographic imaging in women. J Nucl Cardiol 1995, 2:110-116.
32. Bateman TM, O'Keefe JH, Dong VM, Bamhart C: Prognostic significance of nonishcemic SPECT stress myocardial perfusion scintigraphy in females [abstract]. J Nucl Med 1994, 35:60P.
33. Hachamovitch R, Berman DS, Kiat S, Cohen I, Cabiso JA, Friedman J, Diamond GA: Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation 1996, 93:905-914. This study examined 2200 consecutive patients with no known history of CAD and followed them up for close to 2 years for hard events and for referral to coronary angiography or revascularization. These patients were at low overall risk for hard events; despite this, myocardial perfusion SPECT added incremental prognostic information and risk-stratified patients even after clinical and exercise information was known. Referral rates to coronary angiography and revascularization paralleled the hard event rate in all scan categories.
34. Hecht HS, Shaw RE, Bruce RT, Ryan C, Stertzer SH, Myler RK: Usefulness of tomographic thallium-201 imaging for detection of restenosis after percutaneous transluminal coronary angioplasty. Am J Cardiol 1990, 66:1314-1318.
35. Hecht HS, Shaw RE, Chin HL, Ryan C, Stertzer SH, Myler RK: Silent ischemia after coronary angioplasty; evaluation of restenosis and extent of ischemia in asymptomatic patients by tomographic thallium201 exercise imaging and comparison with symptomatic patients. J Am Coll Cardiol 1991, 17:670-677.
36. Palmas W, Bingham S, Diamond GA, Denton TA, Kiat H, Friedman JD, Scarlata D, Maddahi J, Cohen I, Berman DS: Incremental prognostic value of exercise thallium-201 myocardial single photon emission computed tomography late after coronary bypass. J Am Coll Cardiol 1995, 25:403-409.
37. Bateman TM, O'Keefe JH, Dong VM, Barnhart C, Ligon RW: Coronary angiography rates following stress SPECT scintigraphy. J Nucl Cardiol 1995, 2:217-223. The first paper to demonstrate incremental value of myocardial perfusion SPECT imaging over clinical and electrocardiographic information for determining referral for subsequent angiography. Angiography rates were extremely low in patients with normal scans, low for those with nonextensive ischemia, and high in patients with extensive ischemia.
38. Nallamothu N, Pancholy SB, Lee KR, Heo J, Iskandrian AS: Impact of exercise single photon emission computed tomographic thallium imaging on patient management and outcome. J Nucl Cardiol 1995, 2:334-338. This study showed in 2700 patients being evaluated by SPECT imaging that referral to angiography within 6 months after SPECT occurred in 3% of patients with normal scans and 36% of those with abnormal scans.
39. Iskandrian AS, Johnson J, Le TT, Wasserleben V, Cave V, Heo J: Comparison of the treadmill exercise score and single-photon emission computed tomographic thallium imaging in risk assessment J Nucl Cardiol 1994, 1:144-149.
40. Bateman TM, Jones S, Barnhart C, Ligon RW, O'Keefe JH: Can the results of SPECT scintigraphy safely guide clinical management of patients with active CAD? [abstract] J Am Coll Cardiol 1995, 25:46A.
41. Nallamothu N, Ghods M, Heo J, Iskandrian AS: Comparison of thallium-201 single photon emission computed tomography and electrocardiographic response during exercise in patients with normal rest electrocardiographic results. J Am Coll Cardiol 1995, 25:830-836. This is an important paper addressing the potential value of SPECT testing in patients with normal resting ECGs. The authors evaluated 321 patients with a high pretest likelihood for CAD, all of whom had subsequent coronary angiography. Using multivariate discriminant analysis of exercise and thallium variables, multivessel thallium abnormalities, exercise heart rate, and extent of ST segment depression were independent predictors of extensive disease. SPECT was superior to the ECG response in detecting coronary disease and provided incremental power in identifying those patients with extensive CAD.
42. Christian TF, MillerTD, Bailey KR, Gibbons RJ: The incremental value of exercise tomographic thallium-201 imaging for the detection of severe coronary artery disease in patients with normal electrocardiograms at rest Ann Intern Med 1994, 121:825-832.
43. Mahmarian JJ, Mahmarian AC, Marks CF, Pratt CM, Verani MS: Role of adenosine thallium-201 tomography for defining long-term risk in patients after acute myocardial infarction. J Am Coll Cardiol 1995, 25:1333-1340. This study of 146 patients tested with adenosine scintigraphy early after myocardial infarction demonstrates interesting model for predicting risk based on the quantified extent of scintigraphic ischemic and severity of left ventricular dysfunction.
44. Bateman TM, O'Keefe JH, Barnhart C, Jones S, Ligon R: Long-term outcome in patients with negative stress SPECT scintigraphy following PTCA [abstract]. J Am Coll Cardiol 1995, 25:47A.
45. Bateman TM, O'Keefe JH, McGraw JP, Barnhart CS, Ligon RW: Clinical significance of a non-high-risk SPECT scan within 6 months after PTCA [abstract]. J Am Coll Cardiol 1996, 27:47A.
46. Stratmann HG, Younis LT, Wittry MD, Amato M, Miller DD: Exercise technetium-99m myocardial tomography for the risk stratification of men with medically-treated unstable angina pectoris. Am J Cardiol 1995, 76:236-240. This study of 126 patients with unstable angina pectoris who were medically stabilized showed that a normal sestamibi scan was associated with low risk for subsequent cardiac events, whereas a reversible perfusion defect was an independent predictor of increased risk despite continued medical therapy.
47. Miller DD, Stratmann HG, Shaw L, Tamesis BR, Wittry MD, Younis LT, Chaitman BR: Dipyridamole technetium-99m sestamibi myocardial tomography as an independent predictor of cardiac event-free survival after acute ischemic events. J Nucl Cardiol 1994, 1:172-182.
48. Brown KA: Prognostic value of thallium-201 myocardial perfusion imaging in patients with unstable angina who respond to medical treatment J Am Coll Cardiol 1991, 17:1053-1057.