No difference in cardiac event-free survival between positron emission tomography-guided and single-photon emission computed tomography-guided patient management - A prospective, randomized comparison of patients with suspicion of jeopardized myocardium

OBJECTIVES We sought to prospectively compare nitrogen-13 (N-13)-ammonia/(1 8)fluorodeoxyglucose ((18)FDG) positron emission tomography (PET)-guided ma nagement with stress/rest technetium-99m (Tc-99m)-sestamibi single-photon e mission computed tomography (SPECT)-guided management BACKGROUND Patients with evidence of jeopardized (i.e., ischemic or viable) myocardium may benefit from revascularization, whereas patients without it should be treated with drugs. Both PET and SPECT imaging have been proven to delineate jeopardized myocardium. When patient management is based on id entification of jeopardized myocardium, it is unknown which technique is mo st accurate for long-term prognosis. METHODS In a clinical setting, 103 patients considered for revascularizatio n with left ventricular wall motion abnormalities and suspicion of jeopardi zed myocardium underwent both PET and SPECT imaging. The imaging results we re used in a randomized fashion to determine management (percutaneous trans luminal coronary angioplasty [PTCA], coronary artery bypass graft surgery [ CABG] or drug treatment). Follow-up for cardiac events (cardiac death, myoc ardial infarction and revascularization) was recorded for 28 +/- 1 months. The study was designed to have a power of 80% to detect a 20% difference in the event rate between PET and SPECT-based management. RESULTS Management decisions in 49 patients randomized to PET (12 who had P TCA, 14 CABG and 23 drug therapy) were comparable with 54 patients randomiz ed to SPECT (15 who had PTCA, 13 CABG and 26 drug therapy). In terms of car diac event-free survival, no differences between PET and SPECT were observe d (11 vs. 13 cardiac events for PET and SPECT, respectively; p = NS by the Kaplan-Meier statistic). CONCLUSIONS No difference in patient management or cardiac event-free survi val was demonstrated between management based on N-13-ammonia/(18)FDG PET a nd that based on stress/rest Tc-99m-sestamibi SPECT imaging. Both technique s may be used for management of patients considered for revascularization w ith suspicion of jeopardized myocardium. (J Am Cell Cardiol 2001;37:81- 8) (C) 2001 by the American College of Cardiology.