No difference in cardiac event-free survival between positron emission tomography-guided and single-photon emission computed tomography-guided patient management
| Autor: | Willem Vaalburg, Jeroen J. Bax, Harry J.G.M. Crijns, Ernst E. van der Wall, Hans-Marc J. Siebelink, Paul K. Blanksma, Piet L. Jager, T Kingma, Ad J. van Boven, D. Albertus Piers, Jan Pruim |
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| Rok vydání: | 2001 |
| Předmět: |
medicine.medical_specialty
Ischemic cardiomyopathy medicine.diagnostic_test business.industry medicine.medical_treatment Single-photon emission computed tomography Revascularization medicine.disease Coronary artery disease Positron emission tomography Internal medicine Spect imaging Cardiology Medicine Radiology Myocardial infarction business Cardiology and Cardiovascular Medicine Emission computed tomography |
| Zdroj: | Journal of the American College of Cardiology. 37(1):81-88 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/s0735-1097(00)01087-1 |
| Popis: | OBJECTIVES We sought to prospectively compare nitrogen-13 (13N)-ammonia/18fluorodeoxyglucose (18FDG) positron emission tomography (PET)–guided management with stress/rest technetium-99m (99mTc)-sestamibi single-photon emission computed tomography (SPECT)–guided management. BACKGROUND Patients with evidence of jeopardized (i.e., ischemic or viable) myocardium may benefit from revascularization, whereas patients without it should be treated with drugs. Both PET and SPECT imaging have been proven to delineate jeopardized myocardium. When patient management is based on identification of jeopardized myocardium, it is unknown which technique is most accurate for long-term prognosis. METHODS In a clinical setting, 103 patients considered for revascularization with left ventricular wall motion abnormalities and suspicion of jeopardized myocardium underwent both PET and SPECT imaging. The imaging results were used in a randomized fashion to determine management (percutaneous transluminal coronary angioplasty [PTCA], coronary artery bypass graft surgery [CABG] or drug treatment). Follow-up for cardiac events (cardiac death, myocardial infarction and revascularization) was recorded for 28 ± 1 months. The study was designed to have a power of 80% to detect a 20% difference in the event rate between PET- and SPECT-based management. RESULTS Management decisions in 49 patients randomized to PET (12 who had PTCA, 14 CABG and 23 drug therapy) were comparable with 54 patients randomized to SPECT (15 who had PTCA, 13 CABG and 26 drug therapy). In terms of cardiac event-free survival, no differences between PET and SPECT were observed (11 vs. 13 cardiac events for PET and SPECT, respectively; p = NS by the Kaplan-Meier statistic). CONCLUSIONS No difference in patient management or cardiac event-free survival was demonstrated between management based on 13N-ammonia/18FDG PET and that based on stress/rest 99mTc-sestamibi SPECT imaging. Both techniques may be used for management of patients considered for revascularization with suspicion of jeopardized myocardium. |
| Databáze: | OpenAIRE |
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