Different prognosis according to different clinical, electrocardiographic and scintigraphic ischemia criteria

BackgroundTo analyse prognosis according to different clinical, electrocardiographic and scintigraphic responses on stress myocardial perfusion scintigraphy.Methods3579 consecutive patients (age 63.1 ± 12; women: 46.8%) without known coronary artery disease were evaluated with a stress-rest myocardial perfusion single photon emission computed tomography (SPECT). In accordance with clinical (chest pain: ChP), electrocardiographic (ST +) and scintigraphic (SPECT +) ischemia criteria, patients were divided into 5 groups: Group 1 (n = 1902; with normal exercise test and SPECT without ChP); Group 2 (n = 456): ChP −, ST + and SPECT −; Group 3 (n = 594): ChP − and SPECT +; Group 4 (n = 444): ChP + and SPECT −; and Group 5 (n = 183): ChP + and SPECT +.ResultsDuring a follow-up of 5.1 ± 3.4 years, cardiac events (CE: cardiac mortality or nonfatal myocardial infarction) were significantly higher in groups 2 to 5 than in group 1 (p < 0.001). There was a trend to increased CE in patients with silent myocardial ischemia (SMI: Groups 2 and 3) vs symptomatic ischemia (Groups 4 and 5). Predictive value for CE of patients with SMI was HR: 3.1 (95%CI:2.1-4.4), and HR: 2.4 (95%CI:1.5-3.7) of patients with symptomatic ischemia. SMI was observed in 34.6% of diabetic patients vs 28.1% in nondiabetic patients (p = 0.001). Prognosis of patients with ST + plus SPECT + was significantly worse than patients with only ST + or only SPECT + (HR: 1.7, p = 0.026).ConclusionsSMI has incremental prognostic value over clinical variables and symptomatic ischemia. In the context of SMI, a similar prognosis was observed between patients with only ST + and patients with only SPECT +, but significant worse prognosis was observed in patients with ST + plus SPECT +.