Residual exercise SPECT ischemia on treatment is a main determinant of outcome in patients with coronary artery disease treated medically at long-term with ß-blockers
✍ Scribed by Pierre Y Marie; Christelle Mercennier; Nicolas Danchin; Karim Djaballah; Alain Grentzinger; Faïez Zannad; Pierre Olivier; Wassila Djaballah; Gilles Karcher; Jean M Virion; Alain Bertrand
- Publisher
- Springer
- Year
- 2003
- Tongue
- English
- Weight
- 120 KB
- Volume
- 10
- Category
- Article
- ISSN
- 1071-3581
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✦ Synopsis
Background:
Beta-blockers are potent anti-ischemic medications, able to improve prognosis in patients with coronary artery disease (cad). however, it is not known whether beta-blockers have the same beneficial prognostic effect when residual ischemia persists on treatment.
Methods and results:
The prognostic impact of exercise single photon emission computed tomography (spect) ischemia was analyzed in 442 patients with chronic cad, who were treated with beta-blockers and who were referred to exercise thallium 201 spect, while they were receiving their daily-life medications. ischemic and viable myocardium was documented on tl-201 spect in 190 patients (43%), of whom only 23% had angina and only 26% had positive exercise testing results. during a follow-up of 3.8 +/- 1.7 years, 36 patients died and survival curves were progressively divergent between patients with and those without ischemic and viable myocardium: at 5 years, the respective survival rates were 81% +/- 4% and 94% +/- 2% (p =.004). by multivariate analysis, the best independent predictors of death were large extent of necrosis (>25% of left ventricle on tl-201 spect, p <.001) and ischemic and viable myocardium (p =.001).
Conclusions:
In the cad patients treated on a long-term basis with beta-blockers, survival is strongly influenced by persistent exercise spect ischemia on treatment. therefore exercise spect on treatment could be a useful tool for selecting those who might benefit from additional anti-ischemic therapeutic interventions.