Exercise technetium-99m myocardial tomography for the risk stratification of men with medically treated unstable angina pectoris

Am J Cardiol. 1995 Aug 1;76(4):236-40. doi: 10.1016/s0002-9149(99)80072-1.

Abstract

The prognostic value of predischarge maximal exercise stress testing with technetium-99m sestamibi (MIBI) myocardial tomography was assessed in 126 consecutive men hospitalized with a diagnosis of unstable angina pectoris who were medically stabilized. None had coronary revascularization for < or = 6 months after testing. Over a mean follow-up of 12 +/- 7 months (range 1 to 29), 35 patients (28%) had a cardiac event--nonfatal acute myocardial infarction (n = 6), cardiac death (n = 5), or rehospitalization for unstable angina (n = 24). Any type of cardiac event occurred in 12% of patients with normal MIBI scans, compared with 39% of those with an abnormal MIBI scan (p < 0.001) and 60% of those with a reversible perfusion defect (p < 0.0001). Only 2% of patients with normal scans had either a nonfatal myocardial infarction or cardiac death, compared with 14% of those with abnormal MIBI scans (p < 0.05) and 25% with a reversible defect (p < 0.001). A fixed perfusion defect was not associated with increased cardiac risk. With use of multivariable Cox proportional-hazards modeling, the only scintigraphic variable with independent predictive value was the presence of a reversible MIBI defect, with a relative risk of 3.8 (95% confidence interval 1.6 to 8.6, p < 0.05) for any cardiac event, and 19.2 (95% confidence interval 2.2 to 167.0, p < 0.05) for a nonfatal myocardial infarction or cardiac death. Cardiac event-free survival was also significantly decreased in patients with a reversible perfusion defect (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

MeSH terms

  • Adult
  • Aged
  • Angina, Unstable / complications
  • Angina, Unstable / diagnostic imaging*
  • Angina, Unstable / drug therapy
  • Angina, Unstable / mortality
  • Exercise Test* / methods
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Prognosis
  • Proportional Hazards Models
  • Radionuclide Imaging
  • Recurrence
  • Risk Factors
  • Survival Analysis
  • Technetium Tc 99m Sestamibi*

Substances

  • Technetium Tc 99m Sestamibi