Myocardial Perfusion Abnormalities Early (12–24 h) after Coronary Stenting or Balloon Angioplasty: Implications Regarding Pathophysiology and Late Clinical Outcome

Abstract

Objective: We prospectively examined the prevalence of reversible perfusion defects on very early (12–24 h) thallium-201 single photon emission computed tomography (SPECT) scintigraphy after angiographically successful percutaneous coronary intervention (PCI) by stenting and/or stand-alone balloon angioplasty and the predictive value of these defects for late target lesion revascularization (TLR). Patients and Methods: 83 consecutive patients undergoing PCI for 88 lesions (38 balloon angioplasties, 50 stents) underwent very early (12–24 h) SPECT thallium-201 scintigraphy at rest and following administration of 0.7 mg/kg intravenous dipyridamole after PCI. Univariate and multivariate clinical, procedural and scintigraphic correlates of target lesion revascularization during long-term follow-up were examined. Results: Coronary stenting achieved a larger immediate post-PCI minimal luminal dimension (2.7 ± 0.4 vs. 2.1 ± 0.4 mm, p < 0.001) and less residual stenosis (4 ± 12 vs. 19 ± 11%, p < 0.001) than stand-alone balloon angioplasty. Nonetheless, early reversible perfusion defects were similarly present in the territory supplied by 36% of stented lesions and 32% of lesions treated by balloon angioplasty (NS). Of 81 lesions (76 patients) available for long-term clinical follow-up, TLR was performed in 11% of the stent group and 14% of the balloon angioplasty group (NS). By multivariate logistic regression analysis, diabetes mellitus was the only predictor of late TLR (p < 0.05). The type of intervention (balloon or stent) predicted neither early perfusion defects nor late TLR. Conclusions: Early 201-thallium SPECT scintigraphy was abnormal in a third of patients treated by stand-alone balloon angioplasty or by stent placement. The very early SPECT scintigraphic findings did not differentiate between balloon and stent and did not predict late TLR.

Reversible defects on myocardial perfusion imaging early after coronary stent implantation: a predictor of late restenosis

“…Our findings are consistent with those of studies which found that myocardial perfusion imaging predicts late restenosis [3,8,9,23]. Moreover, our binary logistic regression analysis incorporating nine possible .016 * SDS, summed differential score; tREV, mean territorial reversibility; tSDS, territorial summed differential score; *, significant determinants of late restenosis, identified only the presence of a reversible perfusion defect on M-SPECT after stent implantation as an independent predictor (P \ 0.05).…”

“…Similar results have been found by other studies. Jaffe et al [9] evaluated the incidence of reversible perfusion defects after balloon angioplasty and stenting, and found that they were very similar (32% for balloon angioplasty and 36% for stenting; p = NS). Nagaoka et al [10] also observed reversible defects in 36% of patients by M-SPECT four days after stent implantation.…”

“…However, several studies have demonstrated reversible perfusion in the territory supplied by a coronary artery with an optimally implanted stent [8][9][10]. Moreover, the results of these studies concerning the incidence of reversible defects early after coronary stent implantation and their relationship with late restenosis, require clarification.…”

Myocardial Perfusion SPECT Imaging in Patients after Percutaneous Coronary Intervention

“…When MPI is performed very early after angioplasty or stenting (within 24 - 48 hours), it may exhibit defects in the absence of stenoses. These early defects may be due to abnormal endothelium function which is common after angioplasty and may cause transiently impaired coronary flow reserve after intervention, while the prognostic significance of these defects is uncertain [21]. Some authors found that the incidence of restenosis was 52% to 75% in patients with reversible defects on early (<2 months after PCI) imaging, compared with an incidence of 12% to 17% in those with normal perfusion and thus they stated that MPI performed early after PCI could predict future restenosis [22].…”

Utilidade da cintilografia miocárdica na avaliação de pacientes submetidos à revascularização percutânea: importância de seguir as diretrizes

“…Este mesmo autor demonstrou redução da incidência, extensão e gravidade da hipoperfusão transitória pós-aterectomia com o uso do bloqueador da GPIIb/IIIa, o que sugere que a agregação plaquetária, realmente, tenha papel importante na etiologia das alterações perfusionais precoces após RP com aterectomia 9 . Em outro estudo que analisou pacientes após angioplastia ou colocação de stent, os achados perfusionais na CM, nas primeiras 24 horas do procedimento, não predizeram a necessidade de nova revascularização tardia 10 . Outro aspecto importante a ser considerado é o trauma e provável disfunção endotelial associada como causa de alterações perfusionais transitórias.…”