Prognostic value of Tl-201 myocardial scintigraphy after coronary artery bypass grafting

Background Tl-201 myocardial scintigraphy (Tl-201 SPECT) is of strong progn ostic value in various populations with suspected or known coronary artery disease. However, its value in patients with coronary artery bypass graftin g (CABG) is not fully assessed. Methods We examined 115 consecutive patient s to determine the relation between clinical data/stress Tl-201 SPECT perfo rmed 5+/-3 years after CABG, and subsequent cardiac events. Results Thirtee n patients (11%) had stress-induced angina, 22 (19%) had electrical positiv ity, and 97 (84%) had abnormal scintigraphy, including 62 (54%) with revers ible defects. During follow-up (35+/-22 months), there were nine cardiac de aths, seven myocardial infarctions, and 20 revascularization procedures. Mu ltivariate Cox analysis identified the delay between CABG and scintigraphy (P<0.01, relative risk (RR) = 1.01), the extent of stress Tl-201 defects (P = 0.04, RR = 1.18), and increased stress Tl-201 lung uptake (P = 0.03, RR = 3.56) as significant predictors of cardiac deaths/infarctions. Delay betw een CABG and scintigraphy (P < 0.001, RR = 1.01), the extent of stress Tl-2 01 defects (P = 0.03, RR = 1.15), and that of reversible defects (P = 0.05, RR = 1.13) were the only significant predictors of total events. Conclusio ns Besides the delay between CABG and scintigraphy, the scintigraphic param eters were the only significant and additive predictors of cardiac events i n 115 patients with CABG. ((C) 2001 Lippincott Williams & Wilkins).