93 Hellenic Journal of Nuclear Medicine September - December 2015 • www.nuclmed.grJian-Wei Yuan? MD, Yue-Tao Wang? MD,Cun-Zhi Lu? MD1. Department of Nuclear Medicine, The First A?liated Hospital/School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, Guangdong, 510080, China.2. Department of Nuclear Medicine, The First People's Hospital of Changzhou, Changzhou, Jiangsu, 213003, China.3. Department of Nuclear Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu, 221009, ChinaKeywords: SPET Imaging-Myocardial perfusion, - Coronary artery disease-Coronary angiography -Prognosis of CADCorrespondence address: Jian-Wei Yuan, MDDepartment of Nuclear Medicine, The First A?liated Hospital/School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, Guangdong, 510080, China. Tel: +86-20-61325257, Fax: +86-20-61331835 yjwei214@163.comRece?ved: 20 October 2015 Accepted rev?sed: 17 November 2015Coronary arteriography in the diagnosis results and prognosis analysis of suspected coronary artery disease in patients with normal SPET myocardial perfusion imagingAbstractObjective: Anatomic coronary artery disease (CAD) can be determined by coronary angiography (CAG) in patients with normal stress single photon emission tomography (SPET) myocardial perfusion imaging (MPI). Coronary angiography results of patients with negative exercise MPI and the prognosis of these patients (CAG-diagnosed CAD vs. non-CAD) were investigated in the current study. Subjects and Methods: Suspected CAD patients who had SPET-MPI and subsequent CAG studies were retrospectively reviewed from May 2002 to November 2006. Siemens Diacam SPET and Siemens Ecam SPET ?-cameras 99mwere used for the examination of rest/exercise technetium-99m methoxy isobutyl isonitrile ( Tc-MIBI) myocardial imaging. Coronary angiography was performed with Philips arura angiography machine by the standard Judkins method. Results: In all, 6598 patients underwent clinically indicated rest/exercise 99m Tc-MIBI SPET-MPI, and 133 patients underwent CAG despite negative MPI. Thirty one patients were diagnosed with CAD by CAG. Most of these lesions (66%) were located in distal vessels and most of these patients (68%) had 1 vessel disease. Age (P<0.01), hypertension (P<0.01), typical angina pectoris (P<0.01), high pretest likelihood of CAD (P<0.001), exercise induced angina (P<0.05), positive exercise ECG (P<0.01), and transient enlargement of scintigraphic left ventricular size (P<0.05) were signi?cantly di?erent between non-CAD and CAD groups. After median follow-up time of 53±18 months, annualized cardiac event rate was 0.9 % and 0.2 % in CAD and non-CAD group, respectively (??=1.22, P=0.27). Conclusions: In all, 23% of 133 patients in our study we con?rmed anatomic CAD by CAG, despite negative ?ndings in SPET-MPI. Several clinical, stress, and MPI ?ndings could be potential predictors. However, similar to non-99mCAD group, the CAG diagnosed CAD patients who had negative Tc-MIBI SPET-MPI exercise test had a good pro-gnosis with annualized cardiac event rate less than 1.0%.Hell J Nucl Med 2015; 18(3): 215-221 Published online: 5 December 2015 IntroductionIn the last few decades, single-photon emission tomography myocardial perfusion imaging (SPET-MPI) with exercise or pharmacological stress, either with thallium-201 99m(???Tl) or technetium-99m methoxy isobutyl isonitrile ( Tc-MIBI), has been widely used to determine important prognostic information for risk strati?cation and guide management of patients with suspected or known coronary artery disease (CAD) [1-3]. It has been well established that a normal SPET-MPI examination is associated with a very low risk of cardiac events [4]. A meta-analysis of 17 studies identi?ed that the annualized cardiac event rate associated with a normal exercise SPET study was < 1% [5]. The sensitivity and speci?city of SPET-MPI is 87% (95% CI, 86%-88%) and 64% (95% CI, 60%-68%), respectively [6]. Although its sensitivity is particularly high compared to speci?city, in clinical practice, cases with signi?cantly stenotic lesions in coronary angiography (CAG) are sometimes encountered in patients with negative stress SPET-MPI [7]. 99mPrevious studies have assessed the value of a normal Tc-MIBI scan [8-12]. However, the acquired data had some limitations, such as the use of planar studies, no results of CAG and the fact that a few studies reported the prognosis di?erences between CAG diagnosed CAD and non-CAD patients with normal stress MPI. 99mThe results of CAG in suspected CAD patients with negative exercise stress Tc-MIBI SPET-MPI, the prognosis of these patients (CAG diagnosed CAD vs. non-CAD), and the lesion morphology characteristics of CAG diagnosed CAD patients with negative 99mexercise Tc-MIBI SPET-MPI were investigated in the current study. Our study which mainly focuses on the prognosis of these patients, in an Orient population is original and related to previous published data. 215Original Article
