The Prognostic Value Of ^99mtc-sestermibi Ecg-gated Spect Myocardial Perfusion Imaging In Patients With Suspected Coronary Artery Disease

The Prognostic Value of ^99mTc-Sestermibi ECG-Gated SPECT Myocardial Perfusion Imaging In Patients With Suspected Coronary Artery DiseaseObjective: To determine the long-term prognostic value of ^99mTc-sestermibi ECG-gated SPECT myocardial perfusion imaging(G-MPI ) in patients with clinically suspected Coronary Artery Disease(CAD) .Methods:1345 consecutive patients finished ^99mTc- Sestermibi G-MPI study with clinically suspected or determined CAD were included. Patients who underwent revascularization within 60 days after G-MPI study were censored from the progno- stic analysis.,there were 1250 patients finished follow up at last. Semi-quantitative analysis of G-MPI with a scoring system using 17 segments and 0–4 points per segm- ent were used. We retrospectively summarized clinical, scintigraphic, and follow-up data, and analysed by Cox proportional hazards regression and Kaplan–Meier survival analysis.Results: During the follow-up (26.7±13.6 month), 5 Cardiac Deaths and 8 nonfatal Myocardial Infarctions occurred. 25 patients underwent late (>60 d after the nuclear test) revascularization (bypass surgery, 4; coronary angioplasty,21) and 97 patients were in hospital for angina or heart failure. Cox regression analysis indicated that the summed stress score(SSS)(3.8±6.1,χ²= 67.25), summed differient score(SDS)(1.1 ±3.0,χ² = 21.09) and left ventricular ejection fraction(LVEF)(0.667±0.097,χ² = 42.26) were independent predictors of cardiac events (P<0.01), while SSS is the bestpredictors. SSS yielded effective stratification of patient with low or intermedia- te risk by DTS into low, intermediate, and high-risk subgroups.The patients with slight or moderate ischemia (SDS≤7)in MPI have a different cardiac event rate , according to LVEF with those whose LVEF less than 50% worse than those more than 50%. Conclusions: The factors derived from G-MPI such as SSS , SDS and LVEF can independently predict subsequent cardiac events in patients with clinically susp- ectted CAD. Integration of perfusion and function data from G-MPI can improve prognostic value of traditional MPI.