Use of exercise technetiumtium-99m sestamibi SPECT imagina to detect residual ischemia and for risk stratification after acute myocardial infarction

Mark I. Travin, Amr Dessouki, Tina Cameron, Gary V. Helle

Research output: Contribution to journalArticle

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Abstract

The clinical presentation, electrocardiographic findings, and technetium-99m sestamibi single-photon emission computed tomography (SPECT) imaging results of 134 consecutive patients who underwent nuclear exercise testing within 14 days of an acute myocardial infarction (AMI) were correlated with cardiac events over a 15±10-month follow-up. Whereas only 23 patients (17%) had chest pain and 31 (23%) had ischemic ST-segment depression during exercise, 94 (70%) had ischemia on SPECT (p <0.001). On follow-up, 13 patients experienced a cardiac event: 7 were rehospitalized for unstable angina, 3 had recurrent AMI, and 3 died of cardiac causes. Ischemia on the sestamibi images identified 11 of these patients (85%), whereas chest pain identified only 3 (23%, p = 0.006), and electrocardiographic ischemia identified only 4 (31%, p = 0.017). The presence of either ischemia as seen on SPECT or defects in multiple vascular territories identified 12 patients (92%) with an event, including all who had cardiac death. By Cox regression analysis of clinical, stress, and image parameters, the number of ischemic defects on SPECT was the only significant correlate of a future event (chi-sguare = 4.62, p = 0.03), and patients with ≥3 reversible sestamibi defects had an event rate of 38%. The extent of ischemia as seen on nuclear imaging remained a strong correlate (p = 0.008) of an event in the 54 patients (40%) who had received thrombolytic therapy. Thus, exercise technetium-99m sestamibi SPECT after AMI frequently reveals residual ischemia, and is better than clinical data, symptoms, and stress electrocardiographic data in identifying patients who will have a subsequent cardiac event.

Original languageEnglish (US)
Pages (from-to)665-669
Number of pages5
JournalThe American Journal of Cardiology
Volume75
Issue number10
DOIs
StatePublished - Apr 1 1995
Externally publishedYes

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Single-Photon Emission-Computed Tomography
Ischemia
Myocardial Infarction
Exercise
Technetium Tc 99m Sestamibi
Chest Pain
Thrombolytic Therapy
Unstable Angina
Blood Vessels
Regression Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Use of exercise technetiumtium-99m sestamibi SPECT imagina to detect residual ischemia and for risk stratification after acute myocardial infarction. / Travin, Mark I.; Dessouki, Amr; Cameron, Tina; Helle, Gary V.

In: The American Journal of Cardiology, Vol. 75, No. 10, 01.04.1995, p. 665-669.

Research output: Contribution to journalArticle

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abstract = "The clinical presentation, electrocardiographic findings, and technetium-99m sestamibi single-photon emission computed tomography (SPECT) imaging results of 134 consecutive patients who underwent nuclear exercise testing within 14 days of an acute myocardial infarction (AMI) were correlated with cardiac events over a 15±10-month follow-up. Whereas only 23 patients (17{\%}) had chest pain and 31 (23{\%}) had ischemic ST-segment depression during exercise, 94 (70{\%}) had ischemia on SPECT (p <0.001). On follow-up, 13 patients experienced a cardiac event: 7 were rehospitalized for unstable angina, 3 had recurrent AMI, and 3 died of cardiac causes. Ischemia on the sestamibi images identified 11 of these patients (85{\%}), whereas chest pain identified only 3 (23{\%}, p = 0.006), and electrocardiographic ischemia identified only 4 (31{\%}, p = 0.017). The presence of either ischemia as seen on SPECT or defects in multiple vascular territories identified 12 patients (92{\%}) with an event, including all who had cardiac death. By Cox regression analysis of clinical, stress, and image parameters, the number of ischemic defects on SPECT was the only significant correlate of a future event (chi-sguare = 4.62, p = 0.03), and patients with ≥3 reversible sestamibi defects had an event rate of 38{\%}. The extent of ischemia as seen on nuclear imaging remained a strong correlate (p = 0.008) of an event in the 54 patients (40{\%}) who had received thrombolytic therapy. Thus, exercise technetium-99m sestamibi SPECT after AMI frequently reveals residual ischemia, and is better than clinical data, symptoms, and stress electrocardiographic data in identifying patients who will have a subsequent cardiac event.",
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