Long-term prognostic value of Tl-201 single-photon emission computed tomographic myocardial perfusion imaging after coronary stenting

Background The prognostic value of Tl-201 myocardial imaging has been demon strated in several studies concerning patients with a known significant cor onary artery disease. However, the evolution of a coronary stenosis after s tenting is difficult to predict. This study was designed to assess the prog nostic value of Tl-201 single-photon emission computed tomography (thallium SPECT) perfusion imaging in patients after intracoronary stenting. Methods One hundred fifty-two patients were studied. They were followed up during 40 +/- 13 (mean +/- SD) months after thallium SPECT. Stent-related e vents were studied after thallium stress testing and included cardiovascula r death, myocardial infarction, and revascularization. Stress thallium imag ing was performed 5 +/- 2 months after stenting, and ischemia was considere d to be present if at least 2 contiguous segments were showing reversible d efects. Results Only 3 (3%) among the 105 nonischemic patients had major cardiac ev ents during the follow-up versus 13 (28%) of the 47 ischemic patients (P < .001) after thallium SPECT. The relative risk of major cardiac events for p atients with significant ischemia was 10.5 compared with nonischemic patien ts (P < .001). Fourteen (30%) of the ischemic patients and 8 (8%) among the nonischemic patients underwent iterative revascularization (P < .001). The refore, only 11 (10%) of the nonischemic patients had major cardiac events or revascularization compared with 24 (51%) of the ischemic patients (P < . 001). Conclusions Absence of ischemia on thallium SPECT imaging at 5 months after coronary stenting indicates a low risk for cardiovascular events or interv entional procedure. These results may have important clinical implications in patient treatment.