Prognostic value of myocardial perfusion tomographic imaging in patients after percutaneous transluminal coronary angioplasty

Purpose: The authors assessed the prognostic value of stress myocardial per fusion tomographic imaging (SPECT) in patients with recurrent angina or inc onclusive results of exercise electrocardiographic tests after successful p ercutaneous transluminal coronary angioplasty (PTCA), Materials and Methods: After PICA, 70 patients (54 men, 16 women; 41 after myocardial infarction; mean age, 56 +/- 9 years) underwent Tl-201 or Tc-99m sestamibi SPECT studies, SPECT patterns were divided into normal (n = 25), fixed defects (n = 15), and reversible or combined fixed plus reversible d efects (n = 30), A cardiac event was defined as either cardiac death, nonfa tal myocardial infarction, or unstable angina requiring further revasculari zation. Results: During an average follow-up of 25 +/- 10 months, two patients had severe outcomes (one cardiac death and one nonfatal myocardial infarction), and revascularization was required in 13 patients. In patients with normal SPECT or fixed defects, the annual event rate was low (1.2%), with only on e revascularization, in patients with reversible or combined defects, the a nnual event rate was significantly greater (22.4%; chi square = 17.32, P = 0.00003). Conclusions: Normal perfusion or fixed defects predict a benign prognosis i n patients after successful PICA, The presence of stress-induced reversible defects appears to be the best predictor of future cardiac events.