Yonsei Med J.  2017 Sep;58(5):934-943. 10.3349/ymj.2017.58.5.934.

Impact of Follow-Up Ischemia on Myocardial Perfusion Single-Photon Emission Computed Tomography in Patients with Coronary Artery Disease

• Kang SH
• Choi HI
• Kim YH
• Lee EY
• Ahn JM
• Han S
• Lee PH
• Roh JH
• Yun SH
• Park DW
• Kang SJ
• Lee SW
• Lee CW
• Moon DH
• Park SW
• Park SJ

• KMID: 2418928
• DOI: http://doi.org/10.3349/ymj.2017.58.5.934

Abstract

PURPOSE
Few studies have reported on predicting prognosis using myocardial perfusion single-photon emission computed tomography (SPECT) during coronary artery disease (CAD) treatment. Therefore, we aimed to assess the clinical implications of myocardial perfusion SPECT during follow-up for CAD treatment.
MATERIALS AND METHODS
We enrolled 1153 patients who had abnormal results at index SPECT and underwent follow-up SPECT at intervals ≥6 months. Major adverse cardiac events (MACE) were compared in overall and 346 patient pairs after propensity-score (PS) matching.
RESULTS
Abnormal SPECT was associated with a significantly higher risk of MACE in comparison with normal SPECT over the median of 6.3 years (32.3% vs. 19.8%; unadjusted p<0.001). After PS matching, abnormal SPECT posed a higher risk of MACE [32.1% vs. 19.1%; adjusted hazard ratio (HR)=1.73; 95% confidence interval (CI)=1.27-2.34; p<0.001] than normal SPECT. After PS matching, the risk of MACE was still higher in patients with abnormal follow-up SPECT in the revascularization group (30.2% vs. 17.9%; adjusted HR=1.73; 95% CI=1.15-2.59; p=0.008). Low ejection fraction [odds ratio (OR)=5.33; 95% CI=3.39-8.37; p<0.001] and medical treatment (OR=2.68; 95% CI=1.93-3.72; p<0.001) were independent clinical predictors of having an abnormal result on follow-up SPECT.
CONCLUSION
Abnormal follow-up SPECT appears to be associated with a high risk of MACE during CAD treatment. Follow-up SPECT may play a potential role in identifying patients at high cardiovascular risk.

Keyword

Single-photon emission computerized tomography; prognosis; coronary artery disease

MeSH Terms

Coronary Artery Disease/*diagnostic imaging
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Ischemia/*pathology
*Perfusion
Propensity Score
Proportional Hazards Models
Risk Factors
Tomography, Emission-Computed, Single-Photon/*methods
Treatment Outcome

Figure

• 

  Fig. 1 Patient flow. CAD, coronary artery disease; MI, myocardial infarction; SPECT, single-photon emission computed tomography.

• 

  Fig. 2 Kaplan-Meier curves of the cumulative incidence of MACE in patients with normal follow-up SPECT (solid line) versus abnormal followup SPECT (dashed line) in the (A) overall population, (B) medication group, and (C) revascularization group. MACE, major adverse cardiac events; SPECT, single-photon emission computed tomography.

• 

  Fig. 3 Kaplan-Meier curves of the cumulative incidence of MACE in patients with improved (black solid line), no change (dashed line), and worsened (gray solid line) in the result of serial SPECT. MACE, major adverse cardiac events; SPECT, single-photon emission computed tomography.

• 

  Fig. 4 Kaplan-Meier curves of the cumulative incidence of MACE in patients with normal follow-up SPECT (solid line) versus abnormal followup SPECT (dashed line) in the (A) overall population, (B) medication group, and (C) revascularization group in the PS-matched population. MACE, major adverse cardiac events; SPECT, single-photon emission computed tomography; PS, propensity score.

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