Francesco Nudi1,2, Alessandro Nudi1, Giandomenico Neri3, Enrica Procaccini3, Orazio Schillaci4, Francesco Versaci5, Giacomo Frati6,7, Giuseppe Biondi-Zoccai8,9. 1. Service of Hybrid Cardiac Imaging, Madonna della Fiducia Clinic, Rome, Italy. 2. Replycare, Rome, Italy. 3. Ostia Radiologica, Rome, Italy. 4. Institute of Nuclear Medicine, Tor Vergata University, Rome, Italy. 5. UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy. 6. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. 7. IRCCS NEUROMED, Pozzilli, Italy. 8. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy - giuseppe.biondizoccai@uniroma1.it. 9. Mediterranea Cardiocentro, Naples, Italy.
Abstract
BACKGROUND: The management of patients with unprotected left main (LM) coronary artery disease remains challenging, with recent data casting a shadow of doubt on the safety of percutaneous coronary intervention. We aimed at describing the features of patients undergoing myocardial perfusion imaging subsequently found to have LM disease. METHODS: We queried our institutional database for subjects without prior revascularization or myocardial infarction (MI), who had undergone MPI followed by invasive coronary angiography within 6 months, comparing those with evidence of angiographically significant LM disease (i.e. diameter stenosis ≥50%) to those without significant coronary artery disease (CAD), or those with CAD not involving LM. Baseline, stress and imaging features were systematically collected and analyzed, and clinical outcomes (death, myocardial infarction, revascularization) sought. RESULTS: We included a total of 74 patients with LM disease, which were compared with 70 without CAD, and 920 with significant CAD not involving LM. MPI was remarbably safe in all subjects, and significant differences were found for several features, but particularly so for ST change, rate pressure product, and left ventricular ejection fraction (all p<0.05). Most patients with LM disease had moderate or severe ischemia, and the apical, lateral and inferior regions were the most sensitive ones. Clinical outcomes after an average of 35 months were worse in patients with LM disease than in subjects with significant CAD not involving LM, albeit non-significantly, possibly in light of the higher use of coronary artery bypass grafting. CONCLUSIONS: MPI is safe and informative in patients with LM disease, and multidimensional appraisal of MPI results may guide decision-making on top of providing prognostic detail and warranty period.
BACKGROUND: The management of patients with unprotected left main (LM) coronary artery disease remains challenging, with recent data casting a shadow of doubt on the safety of percutaneous coronary intervention. We aimed at describing the features of patients undergoing myocardial perfusion imaging subsequently found to have LM disease. METHODS: We queried our institutional database for subjects without prior revascularization or myocardial infarction (MI), who had undergone MPI followed by invasive coronary angiography within 6 months, comparing those with evidence of angiographically significant LM disease (i.e. diameter stenosis ≥50%) to those without significant coronary artery disease (CAD), or those with CAD not involving LM. Baseline, stress and imaging features were systematically collected and analyzed, and clinical outcomes (death, myocardial infarction, revascularization) sought. RESULTS: We included a total of 74 patients with LM disease, which were compared with 70 without CAD, and 920 with significant CAD not involving LM. MPI was remarbably safe in all subjects, and significant differences were found for several features, but particularly so for ST change, rate pressure product, and left ventricular ejection fraction (all p<0.05). Most patients with LM disease had moderate or severe ischemia, and the apical, lateral and inferior regions were the most sensitive ones. Clinical outcomes after an average of 35 months were worse in patients with LM disease than in subjects with significant CAD not involving LM, albeit non-significantly, possibly in light of the higher use of coronary artery bypass grafting. CONCLUSIONS: MPI is safe and informative in patients with LM disease, and multidimensional appraisal of MPI results may guide decision-making on top of providing prognostic detail and warranty period.