Myocardial technetium-99m sestamibi single-photon emission tomography as a prognostic tool in coronary artery disease: multivariate analysis in a long-term prospective study
Autor: | Biagia Saitta, Franca Chierichetti, Giorgio Ferlin, N. Borsato, Pierluigi Zanco, Adriano Favero, Domenico Rubello, Aldo Zampiero |
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Rok vydání: | 1995 |
Předmět: |
Male
Technetium Tc 99m Sestamibi medicine.medical_specialty Time Factors Multivariate analysis Myocardial Infarction Infarction Coronary Disease Coronary artery disease Risk Factors medicine Humans Radiology Nuclear Medicine and imaging Angina Unstable Prospective Studies Myocardial infarction Prospective cohort study Tomography Emission-Computed Single-Photon Chi-Square Distribution business.industry Unstable angina Incidence (epidemiology) Heart General Medicine Middle Aged Prognosis medicine.disease Logistic Models Relative risk Female Radiology business Follow-Up Studies |
Zdroj: | European Journal of Nuclear Medicine. 22:1023-1028 |
ISSN: | 1619-7089 0340-6997 |
DOI: | 10.1007/bf00808414 |
Popis: | To date several studies have evaluated the accuracy of thallium-201 myocardial scan in risk stratification of coronary artery disease (CAD), while reports using technetium-99m methoxyisobutylisonitrile (MIBI), a tracer particularly suited to single-photon emission tomographic (SPET) imaging, are lacking. To rectify this omission, a prospective study was started in 1988 and at present 176 consecutive, and thus unselected, patients have been enrolled. All of them have been submitted to stress-rest MIBI SPET for the diagnosis or evaluation of CAD; 147 patients (121 males and 26 females, aged 53±9 years) have completed a surveillance period of at least 36 months following the scintigraphic study (range 36–60 months, mean 43). Sixty-one patients had a documented previous myocardial infarction. The mean pretest likelihood of CAD was 44% in the patients without prior infarction. The main anamnestic, clinical, EKG and scintigraphic findings were evaluated and statistically correlated with the incidence of ensuing cardiac events using both univariate (chi-square test) and multivariate analysis (logistic regression model). Twenty-nine patients suffered from a cardiac event during the follow-up period (i.e. three cardiac deaths, six myocardial infarctions and 20 cases of unstable angina). Statistical multivariate analysis identified MIBI scan as the only highly significant and independent prognostic predictor [P=0.006, relative risk (RR)=17.62]. In detail, the most important scintigraphic parameters were the presence of a reversible defect (P=0.0089, RR=5.11) and the extension of the stress perfusion defect (P=0.0255, RR=3.27). The presence of typical angina proved to be a slightly significant predictor (P=0.051, RR=2.45), while no other examined parameter showed a significant correlation with a bad prognosis. In conclusion, MIBI SPET can be considered a useful tool in the risk stratification of CAD patients. The presence of a reversible perfusion defect or an extensive defect appears responsible for a clear increase in the probability of subsequent cardiac events, thus indicating a more aggressive therapeutic approach to be appropriate. |
Databáze: | OpenAIRE |
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