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.
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.
Authors: R F Davies; A D Goldberg; S Forman; C J Pepine; G L Knatterud; N Geller; G Sopko; C Pratt; J Deanfield; C R Conti Journal: Circulation Date: 1997-04-15 Impact factor: 29.690
Authors: P Y Marie; M Angioï; N Danchin; P Olivier; J M Virion; A Grentzinger; G Karcher; Y Juillière; D Fagret; F Cherrier; A Bertrand Journal: J Am Coll Cardiol Date: 1997-11-01 Impact factor: 24.094
Authors: H A Dakik; N S Kleiman; J A Farmer; Z X He; J A Wendt; C M Pratt; M S Verani; J J Mahmarian Journal: Circulation Date: 1998-11-10 Impact factor: 29.690
Authors: Andrew J Yoon; Rowlens M Melduni; Shelly-Ann Duncan; Robert J Ostfeld; Mark I Travin Journal: J Nucl Cardiol Date: 2009-03-06 Impact factor: 5.952
Authors: Wassila Djaballah; Marc A Muller; Michael Angioï; Frédéric Moulin; Andrei Codreanu; Damien Mandry; Gérard Ethevenot; Gilles Karcher; Etienne Aliot; Pierre Y Marie Journal: Eur J Nucl Med Mol Imaging Date: 2007-07-31 Impact factor: 9.236