Key result
Patients with a residual scar from MI early after CABG did not worsen over 100 months, whereas those with early postoperative ischemia had significantly increased long-term perfusion defects (SSS 8.8 vs 3.4, p=0.03) and more clinical events.
Why the study?
Does early post-CABG stress myocardial SPECT predict long-term cardiac events and worsening perfusion in patients with prior myocardial infarction?
Observational (n=24)
No
Does early post-CABG stress myocardial SPECT predict long-term cardiac events and worsening perfusion in patients with prior myocardial infarction?
Absolute Event Rate: 8.8% vs 3.4%
p-value: p=0.03
Early post-CABG stress myocardial SPECT effectively risk-stratifies patients, demonstrating that reversible ischemia, rather than fixed residual scar, predicts future cardiac events and worsening perfusion.
The prognosis for patients with a residual scar from myocardial infarction (MI) after coronary artery bypass grafting surgery (CABG) has not been fully evaluated, so the present study retrospectively evaluated such patients with stress myocardial single photon emission computed tomography (SPECT) at 100 months after CABG. The study group consisted of 24 subjects (23 males, 1 female; mean age, 59+/-9 years) in whom CABG had been performed more than 100 months (mean follow-up period 135+/-25 months) previously. The 24 subjects were classified into 3 groups according to their summed stress score (SSS) and summed reversibility score (SRS) in the early period after CABG. Eight subjects with MI (SSS> or =2 and SRS<2) were classified into the group MI, 8 subjects with ischemic myocardium (SSS> or =2 and SRS> or =2) was classified into the group RE, and 8 subjects with normal perfusion (SSS<2 and SRS<2) was classified into group N. None of the subjects in group MI required revascularization. Cardiac events occurred in 4 of the group RE patients and all required revascularization. As to the SPECT scoring system, the long-term SSS of group MI (6.4+/-3.1) was not different from that in the early periods (4.3+/-4.0; NS). However, the long-term SSS values of group RE (8.8+/-6.2) were significantly greater than those soon after CABG (3.4+/-1.8; p=0.03). In group N, there was also no difference in the SSS values between the early period (0.3+/-0.5) and the long-term period (0.0+/-0.0; NS). Patients with a residual scar from MI in the early period after CABG did not worsen over a period of 100 months. Moreover, there was no significant difference in the SPECT score in the segment with the residual scar in the short or long term after CABG. However, the extent of reversibility was directly associated with the presence of clinical events. Therefore scintigraphic imaging remains an important and clinically relevant risk stratification tool. Stress myocardial SPECT, early after CABG, can be used to predict the possibility of future cardiac events or the need for revascularization.
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Adachi et al. (2002) conducted an observational in Residual scar from myocardial infarction after coronary artery bypass grafting (n=24). Early postoperative myocardial ischemia or residual scar on SPECT vs. Normal perfusion was evaluated on Long-term Summed Stress Score (SSS) compared to early post-CABG SSS in patients with early postoperative ischemic myocardium (Group RE) (p=0.03). Patients with a residual scar from MI early after CABG did not worsen over 100 months, whereas those with early postoperative ischemia had significantly increased long-term perfusion defects (SSS 8.8 vs 3.4, p=0.03) and more clinical events.
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