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References Posted on Heart Board as of this date:
Acta Med Scand. 1988;224(6):539-47.
Predicting long-term mortality after a myocardial infarction from routine hospital data.
Maeland JG, Meen K.
Institute of Hygiene and Social Medicine, University of Bergen, Norway.
Among 528 patients under 67 years of age discharged alive after a myocardial infarction (MI), the cumulative survival rates after 3, 5, and 7 years were 84.1%, 75.9% and 68.6%, respectively. Compared with the "normal" population, the relative mortality risk was 4.8 for the first year, 3.1 for the second, and on average 2.1 for the next 5 years. Significant age differences were not observed for relative mortality. A multivariate Cox proportional hazards model showed long-term mortality to be independently related to higher age, a reduced working activity before the MI, previous cardiovascular disease, and a higher inhospital complication score, which was computed by summing eight defined clinical events weighted for severity. The results indicate that a reasonable prediction of long-term survival after a MI can be made from routine hospital data.
Ned Tijdschr Geneeskd. 1993 Jul 17;137(29):1448-52.
[Long-term prognosis following a myocardial infarct: clinically prognostic variables and cardiovascular risk factors]. [Article in Dutch] Ottervanger JP, Kruijssen HA, Hoes AW, Hofman A. Erasmus Universiteit, Instituut Epidemiologie en Biostatistiek, Rotterdam.
The long-term prognosis after myocardial infarction; clinical predictive variables and cardiovascular risk factors. In predicting long-term survival of 304 consecutive patients discharged after myocardial infarction between 1978 and 1981, and under 65 years of age, the significance of both hospital data and cardiovascular risk factors was examined. After discharge from hospital, the ten-year all-cause total mortality was 35.5%. Sudden death accounted for 42% of the recorded causes of death. The patients were not yet treated with thrombolysis at that time. After multivariate analysis, age, previous myocardial infarction, abnormal chest X-ray (increased cardiothoracic ratio or pulmonary congestion) and an increased cholesterol level were found to be independent and significant predictors of the ten-year mortality. Hypertension and gender were not associated with mortality. Patients with a previous myocardial infarction had, after adjustment for differences in age and other variables, a relative risk of dying within ten years of 1.70 (95% confidence interval 1.05-2.75) compared with those with a first infarction. A gradual increase of the ten-year mortality with elevated serum cholesterol level could be demonstrated (relative risk 1.14 per mmol/l, 95% CI 1.01-1.28). In conclusion, several routinely obtained parameters after myocardial infarction were related to subsequent long-term survival. Of the prognostic factors that may lead to useful therapeutic intervention after myocardial infarction, hypercholesterolaemia was most clearly associated with a reduced survival in the present study.
J Nucl Med. 2009 Apr;50(4):546-53. Epub 2009 Mar 16.
Stress/Rest Myocardial Perfusion Abnormalities by Gated SPECT: Still the Best Predictor of Cardiac Events in Stable Ischemic Heart Disease.
Gimelli A, Rossi G, Landi P, Marzullo P, Iervasi G, L'abbate A, Rovai D.
The prognostic power of myocardial perfusion imaging in patients with ischemic heart disease (IHD) has been demonstrated since planar imaging. We aimed to investigate whether gated SPECT retains this value in current cardiology if compared with a complete diagnostic work-up and with more recent prognostic indicators.
METHODS: We selected from our database a cohort of 676 consecutive inpatients who underwent a complete diagnostic work-up that included gated SPECT and coronary arteriography for known or suspected IHD. Patients with acute myocardial infarction (MI), previous coronary artery bypass surgery, or overt hyperthyroidism and patients who were undergoing dialysis treatment were excluded. During follow-up (median, 37 mo), 24 patients died from cardiac causes and 19 experienced a nonfatal MI.
RESULTS: The following were determined to be independent predictors of event-free survival (cardiac death and nonfatal MI) in the different phases of diagnostic work-up using Cox proportional hazards regression analysis: among clinical variables, a previous MI; among laboratory examinations, serum creatinine and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels; among electrocardiographic and echocardiographic variables, left ventricular ejection fraction; and among SPECT variables, summed rest score (SRS) and summed difference score (SDS). In addition, a score of coronary stenoses at angiography was an independent predictor. When the above predictors were tested together, SRS (P < 0.0001), SDS (P = 0.0108), and serum creatinine (P = 0.0186) and LDL and HDL cholesterol levels (P = 0.0222) were the final independent predictors of event-free survival. When gated SPECT was added to the clinical, laboratory, electrocardiographic, and echocardiographic variables, the prognostic stratification significantly improved (P < 0.05); when coronary arteriography was added to gated SPECT, prognostic stratification did not further improve (P > 0.25). If the information provided by gated SPECT was made available after clinical, laboratory, electrocardiographic, echocardiographic, and angiographic variables, the prognostic stratification still improved significantly (P < 0.05). In 492 of these patients with ascertained IHD, SRS and SDS were the final independent predictors of survival. Medical treatment and coronary revascularization did not affect the prognostic information of gated SPECT.
CONCLUSION: Myocardial perfusion abnormalities at rest and after stress are still the best predictors of cardiac event-free survival in patients with known or suspected IHD, even when compared with an extensive diagnostic work-up.
Heart 2004;90:v10-v15 doi:10.1136/hrt.2003.018770
Assessment of prognosis in chronic coronary artery disease T M Bateman1, E Prvulovich
For many patients with chronic coronary artery disease, risk stratification as to likelihood of cardiac death lays at the basis of choosing between the two major therapeutic options of medical management or revascularisation. The target population is those with an intermediate risk of cardiac death, as patients known to be at high or low risk are already adequately risk stratified for clinical decisions.
Perfusion imaging is frequently used for these purposes because it can separate patients into low (< 1%), intermediate (1–3%), and high (> 3%) likelihoods for the major coronary events. In general, contemplation for revascularisation therapy for patients with mild to moderate symptoms would depend on the likelihood of a major coronary event being greater than 3% per year, in whom revascularisation may confer a survival advantage.
Someone with a < 1% annual event rate might best be managed medically, as the mortality for patients undergoing revascularisation procedures is at least 1%. Management of patients whose perceived risk of a major coronary event is in the range of 1–3% annually will be individualised, considering such factors as age, compliance with important medications known to reduce risk (such as statins, angiotensin converting enzyme (ACE) inhibitors, β blockers), and willingness to undergo periodic follow up.
Clin Physiol Funct Imaging. 2006 Sep;26(5):288-95.
Prognostic value of myocardial perfusion imaging in patients with known or suspected stable angina pectoris: evaluation in a setting in which myocardial perfusion imaging did not influence the choice of treatment. Johansen A, Høilund-Carlsen PF, Vach W, Christensen HW, Møldrup M, Haghfelt T.
Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
Previous investigations on the prognostic value of myocardial perfusion imaging (MPI) were performed under circumstances in which the test result was known to the patient's physician. We wanted to examine the prognostic value of MPI in patients with known or suspected stable angina in a setting in which MPI could not influence the diagnostic and therapeutic strategy.
DESIGN: A prospective series of 507 patients referred to coronary angiography for this condition were examined by MPI before angiography. Management was based on symptoms and angiographic findings, as the results of MPI were not communicated. Patients were followed for a mean of 45.3 +/- 7.7 months.
RESULTS: During follow-up, 20 patients (3.9%) suffered from myocardial infarction, 19 (3.8%) died and eight (1.6%) were revascularized >1 year after MPI resulting in a combined annual event rate of 2.5%. Patients with normal MPI had a low annual event rate of 1.6% (or 1.1% with regard to myocardial infarction or death only). In contrast, event rates in patients with reversible or mixed ischaemia were 4.0% per year. MPI added independent prognostic value to standard clinical data in a multivariate Cox model.
CONCLUSION: We could confirm that in patients with known or suspected stable angina, MPI is a valuable risk stratifying tool.
J Am Coll Cardiol. 2009 Feb 17;53(7):623-32.
Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease.
van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, Wijns W, Stolzmann P, Alkadhi H, Valenta I, Stokkel MP, Kroft LJ, de Roos A, Pundziute G, Scholte A, van der Wall EE, Kaufmann PA, Bax JJ. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
OBJECTIVES: This study was designed to determine whether multislice computed tomography (MSCT) coronary angiography has incremental prognostic value over single-photon emission computed tomography myocardial perfusion imaging (MPI) in patients with suspected coronary artery disease (CAD).
BACKGROUND: Although MSCT is used for the detection of CAD in addition to MPI, its incremental prognostic value is unclear.
METHODS: In 541 patients (59% male, age 59 +/- 11 years) referred for further cardiac evaluation, both MSCT and MPI were performed. The following events were recorded: all-cause death, nonfatal infarction, and unstable angina requiring revascularization.
RESULTS: In the 517 (96%) patients with an interpretable MSCT, significant CAD (MSCT > or =50% stenosis) was detected in 158 (31%) patients, and abnormal perfusion (summed stress score [SSS]: > or =4) was observed in 168 (33%) patients. During follow-up (median 672 days; 25th, 75th percentile: 420, 896), an event occurred in 23 (5.2%) patients. After correction for baseline characteristics in a multivariate model, MSCT emerged as an independent predictor of events with an incremental prognostic value to MPI. The annualized hard event rate (all-cause mortality and nonfatal infarction) in patients with none or mild CAD (MSCT <50% stenosis) was 1.8% versus 4.8% in patients with significant CAD (MSCT > or =50% stenosis). A normal MPI (SSS <4) and abnormal MPI (SSS > or =4) were associated with an annualized hard event rate of 1.1% and 3.8%, respectively. Both MSCT and MPI were synergistic, and combined use resulted in significantly improved prediction (log-rank test p value <0.005).
CONCLUSIONS: MSCT is an independent predictor of events and provides incremental prognostic value to MPI. Combined anatomical and functional assessment may allow improved risk stratification.
Combined use of 64-slice computed tomography angiography and gated myocardial perfusion SPECT for the detection of functionally relevant coronary artery stenoses. First results in a clinical setting concerning patients with stable angina.
Hacker M, Jakobs T, Hack N, Nikolaou K, Becker C, von Ziegler F, Knez A, König A, Klauss V, Tiling R. Klinik und Poliklinik für Nuklearmedizin der LMU, Ziemssenstrasse 1, 80336 München, Germany.
AIM: In patients with stable angina pectoris both morphological and functional information about the coronary artery tree should be present before revascularization therapy is performed. High accuracy was shown for spiral computed tomography (MDCT) angiography acquired with a 64-slice CT scanner compared to invasive coronary angiography (ICA) in detecting "obstructive" coronary artery disease (CAD). Gated myocardial SPECT (MPI) is an established method for the noninvasive assessment of functional significance of coronary stenoses. Aim of the study was to evaluate the combination of 64-slice CT angiography plus MPI in comparison to ICA plus MPI in the detection of hemodynamically relevant coronary artery stenoses in a clinical setting.
PATIENTS, METHODS: 30 patients (63 +/- 10.8 years, 23 men) with stable angina (21 with suspected, 9 with known CAD) were investigated. MPI, 64-slice CT angiography and ICA were performed, reversible and fixed perfusion defects were allocated to determining lesions separately for MDCT angiography and ICA. The combination of MDCT angiography plus MPI was compared to the results of ICA plus MPI.
RESULTS: Sensitivity, specificity, negative and positive predictive value for the combination of MDCT angiography plus MPI was 85%, 97%, 98% and 79%, respectively, on a vessel-based and 93%, 87%, 93% and 88%, respectively, on a patient-based level. 19 coronary arteries with stenoses > or =50% in both ICA and MDCT angiography showed no ischemia in MPI.
CONCLUSION: The combination of 64-slice CT angiography and gated myocardial SPECT enabled a comprehensive non-invasive view of the anatomical and functional status of the coronary artery tree.
J Nucl Cardiol. 2007 Jan;14(1):53-8.
Prognostic value of SPECT myocardial perfusion imaging in patients with elevated cardiac troponin I levels and atypical clinical presentation.
Dorbala S, Giugliano RP, Logsetty G, Vangala D, Mishra R, Crugnale S, Yang D, Di Carli MF.
Division of Nuclear Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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.
Eur J Nucl Med Mol Imaging. 2004 May;31(5):655-62. Epub 2004 Jan 22.
Long-term prognostic value of exercise 99mTc-MIBI SPET myocardial perfusion imaging in patients after percutaneous coronary intervention. Zhang X, Liu X, He ZX, Shi R, Yang M, Gao R, Chen J, Yang Y, Fang W. Cardiovascular Institute and Fu Wai Hospital, PUMC & CAMS, A 167 Beilishilu, 100037 Beijing, China.
The purpose of this study was to evaluate the long-term prognostic value of exercise technetium-99m methoxyisobutylisonitrile ((99m)Tc-MIBI) single-photon emission tomography (SPET) imaging in patients after percutaneous coronary intervention (PCI). Three hundred and eighteen consecutive post-PCI patients who underwent exercise and rest (99m)Tc-MIBI SPET myocardial perfusion imaging (MPI) were followed up for 38+/-27 months. Patients with early revascularisation (<3 months after MPI) were excluded. A semiquantitative visual analysis employing a 20-segment and four-point scoring system was used to define the summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS). Death and non-fatal myocardial infarction (MI) were considered as hard events, and late revascularisation procedures (>/=3 months after MPI) as soft events. Fifty-one patients (16.0%) suffered from cardiac events during follow-up, including 1 (0.3%) death, 13 (4.1%) non-fatal MIs, 9 (2.8%) coronary artery bypass grafting procedures and 28 (8.8%) PCIs. According to the SPET results, patients were classified into three groups: patients with normal MPI (SSS=0, n=153), patients with irreversible defects (SDS<3 and SRS>1, n=100) and patients with reversible defects (SDS>/=3, n=65). The annual hard cardiac event rate in patients with reversible defects was 3.9%, which was significantly higher than that in patients with normal MPI (0.2%, chi(2)=7.71; P<0.01). The annual soft cardiac event rate in patients with reversible defects was 10.7%, which was significantly higher than that in patients with irreversible defects (2.5% chi(2)=17.69; P<0.001), and also significantly higher than that in patients with normal MPI (1.5%, chi(2)=33.89; P<0.001). In patients with normal and reversible defects, there was no significant difference in soft and hard cardiac event rates according to whether patients were symptomatic or asymptomatic ( P>0.05). However, the annual soft event rate in patients with irreversible defects and symptoms was 5.0%, which was higher than that of 0.6% in asymptomatic patients (chi(2)=6.11, P<0.05). Multivariate Cox analysis showed that SSS was the best independent predictor for hard cardiac events (chi(2)=12.70; P<0.001) and SDS was the strongest independent predictor for soft cardiac events (chi(2)=11.72; P<0.001).
Post-PCI patients who have normal exercise (99m)Tc-MIBI SPET MPI have a good long-term prognosis, while those with reversible defects are at a higher risk for future cardiac events, without correlation to the chest pain symptoms.
However, symptomatic patients with irreversible defects have a higher risk for repeat revascularisation, but not for hard events, compared with asymptomatic patients. Exercise (99m)Tc-MIBI SPET MPI has important clinical value for risk stratification and management decision-making in post-PCI patients.
J Nucl Med. 2003 Jul;44(7):1023-9.
Prognostic value of combined assessment of regional left ventricular function and myocardial perfusion by dobutamine and rest gated SPECT in patients with uncomplicated acute myocardial infarction.
Spinelli L, Petretta M, Acampa W, He W, Petretta A, Bonaduce D, Cuocolo A. Institute of Internal Medicine, Cardiology and Heart Surgery, University Federico II, Naples, Italy.
Gated SPECT allows combined assessment of regional myocardial perfusion and left ventricular function. The aim of this study was to address the prognostic value of gated SPECT performed during dobutamine stress testing and during rest on patients with acute myocardial infarction treated with thrombolysis.
METHODS: Eighty-eight consecutive patients with uncomplicated acute myocardial infarction who underwent predischarge (3-7 d after admission) dobutamine (5-40 microg/kg of body weight per minute in 3-min dose increments) and rest gated (99m)Tc-sestamibi SPECT were followed for a mean of 48 mo (range, 4-64 mo).
RESULTS: Eighteen cardiac events (8 cardiac deaths and 10 nonfatal myocardial infarctions) occurred. Ischemia at dobutamine SPECT imaging (summed difference score or=>or= 1) was present in 60% of the patients. In patients without ischemia, there was a lower event rate (11%), compared with patients with mild ischemia (18%) and moderate-to-severe ischemia (40%) (P < 0.05). Patients with events showed also a higher summed difference score, compared with patients without events (2.3 +/- 1.6 vs. 1.3 +/- 1.6, P < 0.05). Independent predictors of events were the number of segments with preserved (99m)Tc-sestamibi uptake at rest and the number of akinetic or dyskinetic segments with preserved (99m)Tc-sestamibi uptake and preserved wall thickening (global chi(2) of the model, 13.6; P < 0.01). The assessment of the incremental prognostic value of variables added sequentially showed that the addition of the summed difference score added information to perfusion status at rest (P < 0.05). Combined assessment of regional myocardial perfusion and left ventricular function at rest further improved the model (P < 0.05).
CONCLUSION: The present study indicated that predischarge (99m)Tc-sestamibi gated SPECT gives prognostic information on patients recovering from acute myocardial infarction. Patients with preserved systolic wall thickening should be regarded as a high-risk subgroup, requiring closer follow-up for appropriate treatment
Clin Nucl Med. 2008 Dec;33(12):852-5.
Comparison of outcome after myocardial infarction in patients with and without abnormalities on previous stress Tc-99m tetrofosmin myocardial perfusion imaging. Elhendy A, Schinkel AF, van Domburg RT, Bax JJ, Feringa HH, Noordzij PG, Schouten O, Karagia nnis SE, Dunkelgrun M, Poldermans D. Thoraxcenter, University Hospital Rotterdam, The Netherlands.
BACKGROUND: Acute myocardial infarction (MI) can occur in patients with previously normal stress myocardial perfusion imaging (MPI). It is not known whether the prognosis of these patients differ from those with MI who had an abnormal MPI on an earlier testing. The aim of this study was to compare the outcome of patients who sustained a MI during follow-up after stress MPI based on the presence or absence of perfusion abnormalities on the earlier test.
METHODS: We studied 109 patients (age 62 +/- 11 years, 73 men) who developed MI 2.1 +/- 2.7 years after exercise or dobutamine stress Tc-99m tetrofosmin MPI. Subsequently, a follow-up was done for the occurrence of death during or after the acute event.
RESULTS: Myocardial perfusion was normal in 31 patients and was abnormal in 78 (45 had reversible defects). During a mean follow-up of 3.1 +/- 2.4 years after MI, death occurred in 35 (32%) patients. The death rate was 19% in patients with previously normal versus 33% in patients with abnormal perfusion (P < 0.01). In a Cox model, independent predictors of death were age (risk ratio (RR) 1.06, 95% CI: 1.02-1.10), heart failure (RR 2.7, CI: 1.3-5.5), and abnormal MPI (RR 2.5, CI: 1.3-4.5).
CONCLUSION: Patients with a previously normal stress MPI are less likely to die after acute MI than patients who had an abnormal MPI.
Eur J Nucl Med Mol Imaging. 2006 Oct;33(10):1157-61. Epub 2006 Jun 9.
Prognostic value of stress 99mTc-tetrofosmin myocardial perfusion imaging in predicting all-cause mortality: a 6-year follow-up study. Elhendy A, Schinkel AF, van Domburg RT, Bax JJ, Valkema R, Biagini E, Poldermans D. Thoraxcenter, Department of Cardiology, University Hospital Dijkzigt, Rotterdam, The Netherlands.
PURPOSE: The aim of this study was to ascertain whether stress myocardial perfusion imaging can independently predict long-term mortality.
METHODS: We studied 1,386 patients with known or suspected coronary artery disease by means of stress 99mTc-tetrofosmin myocardial perfusion tomography. The end point during follow-up was death from any cause. Mortality rates were compared with that in a reference population using calculated age- and gender-specific data in the general population.
RESULTS: Mean age was 60+/-11 years. There were 608 (44%) women. Perfusion abnormalities were fixed in 416 (30%) patients and reversible in 445 (32%) patients. During a mean follow-up of 6+/-1.9 years, 290 (21%) patients died. The annual mortality was 1.7% in patients with normal perfusion and 5.2% in patients with abnormal perfusion. Patients with multivessel distribution of perfusion abnormalities had the highest annual mortality (6.2%). The annual mortality in the reference population was 3.2%. In a multivariate analysis model, predictors of death were age [risk ratio (RR)=1.06, 95% CI 1.04-1.07], male gender (RR=2, CI 1.6-2.6), history of heart failure (RR=2.3, CI 1.8-3.1), diabetes mellitus (RR=2.1, CI 1.6-2.7), smoking (RR=1.8, CI 1.4-2.3), reversible perfusion defects (RR=1.8, CI 1.4-2.5) and fixed perfusion defects (RR=1.7, CI 1.3-2.1).
CONCLUSION: Myocardial perfusion abnormalities on stress 99mTc-tetrofosmin tomography are independently associated with long-term risk of death. The extent of perfusion abnormalities is a major determinant of mortality. The presence of normal perfusion is associated with a lower mortality compared with the general population.
Am J Cardiol. 2006 Jan 1;97(1):1-6. Epub 2005 Nov 4.
Prognostic implications of a normal stress technetium-99m-tetrofosmin myocardial perfusion study in patients with a healed myocardial infarct and/or previous coronary revascularization.
Schinkel AF, Elhendy A, Bax JJ, van Domburg RT, Huurman A, Valkema R, Biagini E, Rizzello V, Feringa HH, Krenning EP, Simoons ML, Poldermans D. Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Previous studies have shown a good outcome for patients who present with normal findings on stress myocardial perfusion imaging. Currently, the prognostic implications of a normal study in patients who have a history of coronary artery disease (CAD) are not clear. This study investigated the long-term prognosis after a normal finding on stress technetium-99m (Tc-99m)-tetrofosmin single-photon emission computed tomography in patients with a history of CAD. The study included 147 consecutive patients with a history of CAD (previous myocardial infarction and/or myocardial revascularization), who underwent exercise bicycle or high-dose dobutamine-atropine stress Tc-99m-tetrofosmin single-photon emission computed tomography, and had normal perfusion results during stress and at rest. Follow-up was completed in all patients. During a follow-up of 6.5 +/- 1.9 years, 20 patients (14%) died, 10 (7%) of whom died due to cardiac causes, and 12 (8%) had a nonfatal myocardial infarction. Annual cardiac death rates were 0.5% during the first 3 years of follow-up and 1.3% in the subsequent 3 years. Independent predictors of cardiac death were male gender, rate-pressure product at rest, and rate-pressure product at peak stress. In conclusion, patients who have a history of CAD have a very low cardiac death rate during the 3 years after a normal finding on stress Tc-99m-tetrofosmin single-photon emission computed tomography. Repeated testing should be reconsidered 3 years after the initial evaluation and when a change in symptoms or clinical condition occurs.
Tex Heart Inst J. 2008; 35(4): 413–418. PMCID: PMC2607100
The Cardioprotective Role of Preinfarction Angina as Shown in Outcomes of Patients after First Myocardial Infarction
Zorica T. Mladenovic, MD, MSc, Andjelka Angelkov-Ristic, MD, PhD, Dragan Tavciovski, MD, PhD, Zdravko Mijailovic, MD, PhD, Branko Gligic, MD, PhD, and Zoran Cosic, MD, PhD Cardiology Department (Drs. Cosic, Mijailovic, Mladenovic, and Tavciovski) and Coronary Unit (Drs. Angelkov-Ristic and Gligic), Military Medical Academy, 11000 Belgrade, Serbia
Patients with preinfarction angina had significantly more myocardial segments with preserved regional contractile function (P <0.0001) and significantly fewer segments with less than 50% perfusion (P=0.008). Stepwise regression analysis identified preinfarction angina (r2=0.317, P=0.032) as a significant predictor of the percentage of left ventricular ejection fraction recovery after the follow-up period. In our study, preinfarction angina was associated with decreased infarct size and with better protection of global and regional left ventricular contractility and improved preservation of the microvasculature. A history of preinfarction angina should be of value in predicting the late clinical outcomes of patients after a 1st acute myocardial infarction.
Optimizing Beta-Blocker Use After Myocardial Infarction
PATRICIA A. HOWARD, PHARM.D., and EDWARD F. ELLERBECK, M.D., M.P.H.
University of Kansas Medical Center, Kansas City, Kansas A patient information handout on beta blockers,