Prognostic value of SPECT myocardial perfusion imaging in patients with elevated cardiac troponin I levels and atypical clinical presentation

✍ Scribed by Sharmila Dorbala; Robert P. Giugliano; Giridhar Logsetty; Divya Vangala; Rakesh Mishra; Sharon Crugnale; David Yang; Marcelo F. Di Carli

• Publisher: Springer
• Year: 2007
• Tongue: English
• Weight: 110 KB
• Volume: 14
• Category: Article
• ISSN: 1071-3581
• DOI: 10.1016/j.nuclcard.2006.07.010

✦ Synopsis

Background:

We determined the prognostic value of myocardial perfusion imaging (mpi) in patients with atypical clinical presentations and unexpected elevation of cardiac troponin i (ctni) levels.

Methods and results:

In 156 consecutive patients with atypical presentations for acute coronary syndromes (acs) and elevated ctni levels undergoing mpi within 30 days, rates of all-cause mortality (100% follow-up; median follow-up, 611 days) and 6-month cardiac death and nonfatal myocardial infarction (96% follow-up; median follow-up, 167 days) were determined. the mean age of the patients was 68 +/- 14 years. the majority of the study cohort (96%) was at low to intermediate clinical risk for acs (thrombolysis in myocardial infarction score for unstable angina/non-st-segment elevation myocardial infarction <5). the overall event rate was high, with 45 deaths (28.8%). there were 13 cardiac deaths/nonfatal myocardial infarctions in 6 months (8.3%). a normal mpi result was associated with a high event-free survival rate, whereas an abnormal mpi result was associated with a 3-fold and 7-fold higher risk of all-cause mortality and 6-month cardiac events, respectively. an abnormal mpi result was an independent predictor of all-cause death.

Conclusions:

In patients with ctni elevation and a low to intermediate risk for acs, a normal mpi result portends a good prognosis. patients with abnormal mpi results have a higher 6-month cardiac event rate and a worse survival rate.