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.
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.
Authors: Manuel D Cerqueira; Neil J Weissman; Vasken Dilsizian; Alice K Jacobs; Sanjiv Kaul; Warren K Laskey; Dudley J Pennell; John A Rumberger; Thomas Ryan; Mario S Verani Journal: Circulation Date: 2002-01-29 Impact factor: 29.690
Authors: K J Silverman; L C Becker; B H Bulkley; R D Burow; E D Mellits; C H Kallman; M L Weisfeldt Journal: Circulation Date: 1980-05 Impact factor: 29.690
Authors: I A Khan; A Tun; N Wattanasauwan; M T Win; T A Hla; A Hussain; B C Vasavada; T J Sacchi Journal: Am J Emerg Med Date: 1999-05 Impact factor: 2.469
Authors: Michael X Pham; Mary A Whooley; G Thomas Evans; Catherine Liu; Homeira Emadi; Winnie Tong; M Catherine Murphy; Kirsten E Fleischmann Journal: Am Heart J Date: 2004-11 Impact factor: 4.749
Authors: D S Berman; R Hachamovitch; H Kiat; I Cohen; J A Cabico; F P Wang; J D Friedman; G Germano; K Van Train; G A Diamond Journal: J Am Coll Cardiol Date: 1995-09 Impact factor: 24.094
Authors: E M Antman; M J Tanasijevic; B Thompson; M Schactman; C H McCabe; C P Cannon; G A Fischer; A Y Fung; C Thompson; D Wybenga; E Braunwald Journal: N Engl J Med Date: 1996-10-31 Impact factor: 91.245
Authors: R S Gibson; D D Watson; G B Craddock; R S Crampton; D L Kaiser; M J Denny; G A Beller Journal: Circulation Date: 1983-08 Impact factor: 29.690
Authors: R Parker Ward; Mouaz H Al-Mallah; Gabriel B Grossman; Christopher L Hansen; Robert C Hendel; Todd C Kerwin; Benjamin D McCallister; Rupa Mehta; Donna M Polk; Peter L Tilkemeier; Aseem Vashist; Kim Allan Williams; David G Wolinsky; Edward P Ficaro Journal: J Nucl Cardiol Date: 2007 Nov-Dec Impact factor: 5.952
Authors: Sara L Partington; Viswanatha Lanka; Jon Hainer; Ron Blankstein; Hicham Skali; Daniel E Forman; Marcelo F Di Carli; Sharmila Dorbala Journal: J Nucl Cardiol Date: 2012-05-08 Impact factor: 5.952