Myocardial perfusion scintigraphy for risk stratification of patients with coronary artery disease: the AMICO registry

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
NR Pugliese ◽  
R Buechel ◽  
M Coceani ◽  
A Clemente ◽  
PA Kaufmann ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Primary Endpoint ◽  
Myocardial Perfusion Scintigraphy ◽  
Composite Endpoint ◽  
Cardiovascular Death ◽  
Rank Test ◽  
Perfusion Scintigraphy ◽  
Coronary Anatomy ◽  
Log Rank Test ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. onbehalf AMICO registry Background. Clinical evidence promotes therapy titration based on patient risk stratification in coronary artery disease (CAD). Purpose. We assessed the prognostic value of myocardial perfusion scintigraphy (MPS) with cadmium-zinc-telluride in addition to clinical and coronary anatomy analysis. Methods and Results. We prospectively enrolled 1464 patients (26% females, 69.5 ± 10.4 years) referred for stress-rest MPS. All the patients underwent invasive coronary angiography (1171, 80%) or coronary computed tomography angiography (293, 20%). We defined a composite endpoint of cardiovascular death and non-fatal MI. After a median follow-up of 3.5 years (interquartile range 2 – 6 years), we observed 127 events (Table). Summed stress score (SSS) had the highest accuracy in predicting primary endpoint with a ROC-derived cut-off of SSS > 8 (>10% myocardium). SSS > 8 portended the lowest survival probability at Kaplan–Meier analysis (p < 0.0001; Figure A). The Cox-regression analysis indicated SSS as an independent predictor of the composite endpoint, along with fasting blood glucose and total cholesterol and contrary to coronary anatomy parameters. Patients with SSS > 8 treated with optimal medical therapy (OMT) had the largest area of necrosis, the lower ischemic burden, the most compromised LV systo-diastolic function and the highest LV mass, but received a less aggressive treatment in comparison to early revascularized patients. Survival analysis revealed patients with SSS ≤ 8 had the greater freedom from events, irrespective of the treatment strategy, while the group with SSS > 8 and OMT had the worst outcome, followed by patients with SSS > 8 and early revascolarization (log-rank test: all p < 0.0001). Plotting the estimates from proportional-hazard modelling against SSS (reference level: SSS = 4) shows a risk curve for the primary endpoint that increase for SSS > 4 and reach a plateau for values >12 (Figure B).  Conclusion. The extension of stress perfusion abnormalities constitutes a robust independent predictor of future adverse events after adjustment for multiple clinical parameters and coronary anatomy analysis. MPS could help refine risk stratification of patients with known or suspected CAD. Primary and secondary endpoints Variable Total population (n = 1464) SSS > 8 (n = 591) SSS ≤ 8 (n = 873) Hazard Ratio (95% CI)* P-value* Primary endpoint 127 (9) 85 (14) 42 (5) 3.25 (2.25 - 4.70) <0.0001 Cardiovascular death 50 (3) 37 (6) 13 (1) 4.53 (2.41 - 8.51) <0.0001 Non-fatal MI 84 (6) 53 (9) 31 (4) 2.71 (1.75 - 4.22) <0.0001 *The hazard ratio is for the SSS > 8 group as compared with the summed stress score (SSS)≤8 group, and P-values were calculated by the log-rank test and are unadjusted for multiple variables. Abstract Figure

Myocardial perfusion scintigraphy for risk stratification of patients with coronary artery disease: the AMICO registry

2020 ◽  
Author(s):  
Alessia Gimelli ◽  
Nicola Riccardo Pugliese ◽  
Ronny R Buechel ◽  
Michele Coceani ◽  
Alberto Clemente ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Risk Stratification ◽  
Myocardial Perfusion Scintigraphy ◽  
Independent Predictor ◽  
Composite Endpoint ◽  
Perfusion Scintigraphy ◽  
Coronary Anatomy ◽  
Cox Regression Analysis ◽  
Early Revascularization

Abstract Aims We assessed the prognostic value of myocardial perfusion scintigraphy (MPS) with cadmium–zinc–telluride in addition to clinical and coronary anatomy analysis. Methods and results We prospectively enrolled 1464 patients (26% females, 69.5 ± 10.4 years) referred for stress-rest MPS. All the patients underwent invasive coronary angiography (1171, 80%) or coronary computed tomography angiography (293, 20%). We defined a composite endpoint of cardiovascular death and non-fatal MI. After an 8-year follow-up, summed stress score (SSS) had the highest accuracy in predicting primary endpoint with a ROC-derived cut-off of SSS >8 (>10% myocardium). SSS >8 portended the lowest survival probability at Kaplan–Meier analysis (P < 0.0001 for the composite endpoint and individual components). The Cox-regression analysis indicated SSS as an independent predictor of the composite endpoint, along with fasting blood glucose and total cholesterol and contrary to coronary anatomy parameters. Patients with SSS >8 treated with optimal medical therapy (OMT) had the largest area of necrosis, the lower ischaemic burden, the most compromised LV systo-diastolic function and the highest LV mass, but received a less aggressive treatment in comparison to early revascularized patients. Survival analysis revealed patients with SSS ≤8 had the greater freedom from events, irrespective of the treatment strategy, while the group with SSS >8 and OMT had the worst outcome, followed by patients with SSS >8 and early revascularization (log-rank test: all P < 0.0001). Conclusion MPS-SSS constitutes a strong independent predictor of future adverse events after adjustment for multiple clinical parameters and coronary angiography. In particular, MPS could help risk stratification of patients who did not undergo early revascularization.

Impact of chronic kidney disease on mid-term prognosis of stable angina patients with high-dose or low-dose pitavastatin treatment: REAL-CAD sub-study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Abe ◽  
Y Ozaki ◽  
H Takahashi ◽  
M Akao ◽  
T Kimura ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Cardiovascular Events ◽  
Low Dose ◽  
Coronary Revascularization ◽  
Composite Endpoint ◽  
Japanese Patients ◽  
Cardiovascular Death ◽  
High Dose ◽  
Artery Disease ◽  
Emergency Hospitalization

Abstract Background We previously demonstrated that high-dose (4 mg/day) compared with low-dose (1 mg/day) pitavastatin therapy significantly reduced cardiovascular events in Japanese patients with stable coronary artery disease in the Randomized Evaluation of Aggressive or Moderate Lipid Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD) study. However, little is known about whether the advantage of high-dose statins over low-dose statins is consistent among non-, mild, and moderate to severe chronic kidney disease (CKD) patients. Purpose The aim of this study was to clarify the effect of high-dose statins on cardiovascular events in Japanese patients with or without CKD. Methods The REAL-CAD study is a prospective, multicenter, randomized, open-label, blinded endpoint, physician-initiated superiority trial. In this sub-analysis of REAL-CAD study, patients were categorized into three groups according to estimated glomerular filtration rate (eGFR). Patients on hemodialysis were excluded in this study. The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction (MI), non-fatal ischemic stroke, or unstable angina requiring emergency hospitalization. A secondary composite endpoint was defined as a composite of the primary endpoint event or clinically-indicated coronary revascularization excluding target-lesion revascularization. Results The total population of the REAL-CAD study was 12,413 patients. After exclusion of patients lacking eGFR data, the numbers of patients categorized into non-CKD (eGFR ≥60 mL/min/1.73m2), mild CKD (eGFR; 45–60), and moderate to severe CKD (eGFR <45) were 7,778 (64%), 3,176 (26%), and 1,164 (10%), respectively. The median follow-up period was 3.9 years. The baseline characteristics and medications were well balanced between the two groups in each CKD group. While high-dose compared to low-dose pitavastatin significantly reduced the primary endpoint in non-CKD patients, the effect was not observed in mild CKD and moderate to severe CKD patients (Figure 1). High-dose compared with low-dose pitavastatin did not significantly reduce the secondary composite endpoint in both mild and moderate to severe CKD patients as well. High-dose pitavastatin significantly reduced the risks of MI and any coronary revascularization in non-CKD patients, however, the effects were diminished in mild CKD and moderate to severe CKD patients. There was no significant difference between high-dose and low-dose pitavastatin treatment in the risk of all-cause death, cardiovascular death, ischemic stroke, or unstable angina requiring emergency hospitalization in patients with or without CKD. Conclusion Although high-dose pitavastatin therapy significantly reduced cardiovascular events in non-CKD patients with stable angina compared to low-dose pitavastatin, such beneficial effects had diminished in Japanese patients with mild or moderate to severe CKD patients. Figure 1. Kaplan-Meier Curves for Endpoints Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Clinical Research of Lifestyle-Related Disease of the Public Health Research Foundation

scholarly journals α-Hydroxybutyrate dehydrogenase is associated with atherothrombotic events following infrainguinal angioplasty and stenting

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Silvia Lee ◽  
Renate Koppensteiner ◽  
Christoph W. Kopp ◽  
Thomas Gremmel
Keyword(s):  
Primary Endpoint ◽  
Composite Endpoint ◽  
Cardiovascular Death ◽  
Roc Curve Analysis ◽  
First Occurrence ◽  
Predictive Role ◽  
Artery Disease ◽  
Underlying Mechanisms ◽  
Ischemic Attack ◽  
Angioplasty And Stenting

AbstractBesides clinical characteristics, easy-accessible laboratory markers could be of value to refine risk stratification in peripheral artery disease. In the current study, we investigated whether α-hydroxybutyrate dehydrogenase (HBDH) is associated with atherothrombotic events in 83 stable patients undergoing infrainguinal angioplasty and stenting. The primary endpoint was defined as the composite of the first occurrence of nonfatal myocardial infarction, nonfatal stroke or transient ischemic attack and cardiovascular death within 2 years after angioplasty and stenting, and occurred in 6 patients (7.2%). HBDH levels at baseline were significantly higher in patients who subsequently developed the primary endpoint (126 U/L [116–137 U/L] vs. 105 U/L [95–120 U/L]; p = 0.04). ROC curve analysis revealed that HBDH could distinguish between patients without and with future atherothrombotic events. A HBDH concentration ≥ 115 U/L was identified as the best threshold to predict the composite endpoint, providing a sensitivity of 83.3% and a specificity of 71.4%, and was therefore defined as high HBDH. High HBDH was seen in 28 patients (33.7%). Ischemic events occurred significantly more often in patients with high HBDH than in patients with lower HBDH levels (5 vs. 1 patients, p = 0.007). In conclusion, HBDH is associated with the occurrence of atherothrombotic events after infrainguinal angioplasty with stent implantation. Future trials are warranted to study the predictive role of HBDH for ischemic outcomes and to investigate underlying mechanisms.

Myocardial perfusion scintigraphy: image interpretation

2017 ◽  
Author(s):  
Nikant Sabharwal ◽  
Parthiban Arumugam ◽  
Andrew Kelion
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Myocardial Perfusion Scintigraphy ◽  
Photon Emission ◽  
Image Interpretation ◽  
Left Ventricular ◽  
Emission Computed Tomography ◽  
Perfusion Scintigraphy ◽  
Artery Disease

This chapter focuses on image interpretation in myocardial perfusion scintigraphy. It covers planar acquisitions, the general approach to reporting single photon emission computed tomography (SPECT) images, and both qualitative and quantitative evaluation of tomographic slices. Detail is also provided on gated SPECT and attenuation correction, as well as a range of artefacts including image, instrumentation-related, and patient-related artefacts. Information is provided on abnormal appearances in coronary artery disease, perfusion defects, and indirect markers of severe coronary artery disease. The chapter also covers interpretation in left ventricular dysfunction and appearances in non-coronary cardiac disease, and includes a section on writing a useful report.

scholarly journals Regadenoson myocardial perfusion scintigraphy for the evaluation of coronary artery disease in patients with lung disease: A series of five cases

2019 ◽  
Vol 27 (1) ◽  
pp. 315-321 ◽  
Author(s):  
Eliana Reyes ◽  
Stephen Richard Underwood
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Myocardial Perfusion Scintigraphy ◽  
Case Series ◽  
Pharmacological Stress ◽  
Perfusion Scintigraphy ◽  
Serious Adverse Events ◽  
Artery Disease ◽  
Respiratory Conditions

AbstractCoronary artery disease (CAD) is a leading cause of death and morbidity globally. Myocardial perfusion scintigraphy (MPS) is commonly used for the diagnosis of CAD, necessitating hyperaemia achieved either by physical exertion or by pharmacological stress, most commonly through use of a coronary arteriolar dilator. This is challenging in patients with respiratory conditions because exercise may be submaximal and adenosine is contraindicated because of the risk of bronchoconstriction. Regadenoson is the only selective adenosine A2A receptor agonist approved as a vasodilator in MPS. The risk of bronchospasm with regadenoson has been investigated in large, randomised trials; however, patients with the most severe respiratory conditions were not included. In this case series, we present the use of regadenoson MPS in five patients with moderate-to-severe lung conditions, including patients requiring lung volume reduction surgery and lung transplant. In all cases, regadenoson MPS provided valuable information for risk assessment and treatment optimisation. Although dyspnoea occurred in all patients, regadenoson was well tolerated without serious adverse events or bronchospasm; in no case was intervention required to treat dyspnoea.

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