Different prognosis according to different clinical, electrocardiographic and scintigraphic ischemia criteria. (15th September 2016)

• Record Type: Journal Article
• Authors: Romero-Farina, Guillermo; Candell-Riera, Jaume; Aguadé-Bruix, Santiago; Pizzi, María N.; García-Dorado, David
• Is Part Of: International journal of cardiology. Volume 219(2016)
• Page Start: 240
• Page End: 246
• Publication Date: 2016-09-15
• Subjects: Gated SPECT -- Cardiac events -- Silent myocardial ischemia -- ST segment depression -- Myocardial perfusion ischemia; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.06.042
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: To analyse prognosis according to different clinical, electrocardiographic and scintigraphic responses on stress myocardial perfusion scintigraphy. Methods: 3579 consecutive patients (age 63.1 ± 12; women: 46.8%) without known coronary artery disease were evaluated with a stress-rest myocardial perfusion single photon emission computed tomography (SPECT). In accordance with clinical (chest pain: ChP), electrocardiographic (ST +) and scintigraphic (SPECT +) ischemia criteria, patients were divided into 5 groups: Group 1 (n = 1902; with normal exercise test and SPECT without ChP); Group 2 (n = 456): ChP −, ST + and SPECT −; Group 3 (n = 594): ChP − and SPECT +; Group 4 (n = 444): ChP + and SPECT −; and Group 5 (n = 183): ChP + and SPECT +. Results: During a follow-up of 5.1 ± 3.4 years, cardiac events (CE: cardiac mortality or nonfatal myocardial infarction) were significantly higher in groups 2 to 5 than in group 1 (p < 0.001). There was a trend to increased CE in patients with silent myocardial ischemia (SMI: Groups 2 and 3) vs symptomatic ischemia (Groups 4 and 5). Predictive value for CE of patients with SMI was HR: 3.1 (95%CI:2.1–4.4), and HR: 2.4 (95%CI:1.5–3.7) of patients with symptomatic ischemia. SMI was observed in 34.6% of diabetic patients vs 28.1% in nondiabetic patients (p = 0.001). Prognosis of patients with ST + plus SPECT + was significantly worse than patients with only ST + or only SPECT + (HR: 1.7, p = 0.026). Conclusions: SMI has incremental prognostic value over clinical variables and symptomatic ischemia. In the context of SMI, a similar prognosis was observed between patients with only ST + and patients with only SPECT +, but significant worse prognosis was observed in patients with ST + plus SPECT +.