Elsevier

Journal of Nuclear Cardiology

Volume 10, Issue 3, May–June 2003, Pages 261-266
Journal of Nuclear Cardiology

Long-term prognosis after a normal exercise stress Tc-99m sestamibi SPECT study

https://doi.org/10.1016/S1071-3581(02)43219-9Get rights and content

Abstract

Background

Patients with a normal stress technetium 99m sestamibi study were shown to have a favorable outcome at intermediate-term follow-up. However, long-term survival has not been studied. The aim of this study was to evaluate the incidence and predictors of mortality and cardiac events at long-term follow-up after a normal exercise stress sestamibi study.

Methods and results

We studied 218 patients (mean age, 53 ± 10 years, 108 men) who had normal myocardial perfusion assessed by Tc-99m sestamibi single photon emission computed tomography at rest and during symptom-limited bicycle exercise stress test. Endpoints during a follow-up period of 7.4 ± 1.8 years were hard cardiac events (cardiac death and nonfatal myocardial infarction) and all-cause mortality. During follow-up, 13 patients died of various causes (cardiac death in 1 patient). Ten patients had nonfatal myocardial infarction (a total of 11 hard cardiac events). By multivariate analysis, independent predictors of cardiac events were history of coronary artery disease2 = 5, P = .03) and lower exercise heart rate (χ2 = 12, P = .001). Independent predictors of all-cause mortality were age (χ2 = 4, P = .05) and exercise heart rate (χ2 = 5, P = .03). The annual mortality rate was 0.6% in the first 5 years and 1.8% between the sixth and eighth years. The annual hard cardiac event rate was 0.7% in the first 5 years and 1.5% between the sixth and eighth years. Receiver operating characteristic curves identified an exercise heart rate lower than 130 beats/min as the cutoff value that separated patients with regard to their risk for mortality and hard cardiac events.

Conclusions

It is concluded that the annual mortality and cardiac event rate is less than 1% during 5-year follow-up after a normal exercise sestamibi study. Therefore repeated testing would not be required unless there is a change in symptoms. Follow-up should be closer in patients with a history of coronary artery disease and in those who fail to achieve an exercise heart rate of 130 beats/min or greater.

Section snippets

Patient selection

The study population comprised consecutive patients referred for exercise stress testing in conjunction with Tc-99m sestamibi SPECT between 1988 and 1995, who had normal myocardial perfusion at rest and during exercise stress testing. Patients with significant valvular heart disease were excluded from this study. Patients with unstable chest pain were generally excluded from stress testing. Follow-up data were collected in the year 2000 and could be completed in all patients. The mean follow-up

Clinical features

The patients’ mean age was 53 ± 10 years. There were 108 men and 110 women. Forty-seven patients (twenty-two percent) had a history of CAD (previous non–Q-wave myocardial infarction in 14 patients and previous coronary angioplasty in 33 patients studied 1.2 ± 2.1 years after the intervention). None of the patients had previous coronary artery bypass surgery. In the remaining patients, the pretest probability of CAD based on the classification of Diamond and Forrester25 was low in 57 patients

Discussion

In this study we assessed the long-term outcome of 218 patients with suspected or known CAD who were followed up for a mean of 7.4 years after a normal exercise stress Tc-99m sestamibi study. The annual mortality rate was 0.6% in the first 5 years and 1.8% between the sixth and eighth years. The hard cardiac event rate was 0.7% in the first 5 years and 1.5% between the sixth and eighth years. Therefore the study demonstrated that the low-risk warrantee of a normal exercise sestamibi study

Acknowledgements

The authors have indicated they have no financial conflicts of interest.

References (29)

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