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

Henry G. Stratmann, Liwa T. Younis, Mark D. Wittry, Maryellen Amato, D. Douglas Miller

Research output: Contribution to journalArticle

48 Scopus citations

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 ≤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). Thus, exercise stress MIBI tomography provides long-term prognostic information in patients with unstable angina who can be medically stabilized before hospital discharge. A normal MIBI scan is associated with a low risk of subsequent cardiac events, whereas a reversible perfusion defect is an independent predictor of increased cardiac risk despite continued medical therapy.

Original languageEnglish (US)
Pages (from-to)236-240
Number of pages5
JournalThe American Journal of Cardiology
Volume76
Issue number4
DOIs
Publication statusPublished - Aug 1 1995
Externally publishedYes

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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