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, Donald D Miller

Research output: Contribution to journalArticle

48 Citations (Scopus)

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
StatePublished - Aug 1 1995

Fingerprint

Technetium
Unstable Angina
Tomography
Exercise
Perfusion
Myocardial Infarction
Confidence Intervals
Technetium Tc 99m Sestamibi
Disease-Free Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Exercise technetium-99m myocardial tomography for the risk stratification of men with medically treated unstable angina pectoris. / Stratmann, Henry G.; Younis, Liwa T.; Wittry, Mark D.; Amato, Maryellen; Miller, Donald D.

In: The American Journal of Cardiology, Vol. 76, No. 4, 01.08.1995, p. 236-240.

Research output: Contribution to journalArticle

Stratmann, Henry G. ; Younis, Liwa T. ; Wittry, Mark D. ; Amato, Maryellen ; Miller, Donald D. / Exercise technetium-99m myocardial tomography for the risk stratification of men with medically treated unstable angina pectoris. In: The American Journal of Cardiology. 1995 ; Vol. 76, No. 4. pp. 236-240.
@article{7d53ae4bdb0c4c49961e7d132868cb60,
title = "Exercise technetium-99m myocardial tomography for the risk stratification of men with medically treated unstable angina pectoris",
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.",
author = "Stratmann, {Henry G.} and Younis, {Liwa T.} and Wittry, {Mark D.} and Maryellen Amato and Miller, {Donald D}",
year = "1995",
month = "8",
day = "1",
doi = "10.1016/S0002-9149(99)80072-1",
language = "English (US)",
volume = "76",
pages = "236--240",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Exercise technetium-99m myocardial tomography for the risk stratification of men with medically treated unstable angina pectoris

AU - Stratmann, Henry G.

AU - Younis, Liwa T.

AU - Wittry, Mark D.

AU - Amato, Maryellen

AU - Miller, Donald D

PY - 1995/8/1

Y1 - 1995/8/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0029145789&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029145789&partnerID=8YFLogxK

U2 - 10.1016/S0002-9149(99)80072-1

DO - 10.1016/S0002-9149(99)80072-1

M3 - Article

C2 - 7618615

AN - SCOPUS:0029145789

VL - 76

SP - 236

EP - 240

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 4

ER -