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DOI: 10.1148/radiol.2321030279
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(Radiology 2004;232:58-65.)
© RSNA, 2004

Nuclear Medicine

Outcome Prediction in Patients at High Risk for Coronary Artery Disease: Comparison between 99mTc Tetrofosmin and 99mTc Sestamibi1

Salvador Borges-Neto, MD, Robert H. Tuttle, MS, Linda K. Shaw, MS, William T. Smith, IV, MD, Diwakar Jain, MD, R. Edward Coleman, MD and David Whellan, MD

1 From the Departments of Medicine (Cardiology) (S.B.N., R.H.T., L.K.S., W.T.S., D.W.) and Radiology (Nuclear Medicine) (S.B.N., R.E.C.) and Duke Clinical Research Institute and Drexel School of Medicine (Cardiology) (D.J.), Duke University Medical Center, PO Box 3949, Durham, NC 27710. Received February 13, 2003; revision requested May 7; revision received October 9; accepted November 12. This study was supported in part by an unrestricted grant from Amersham Health. Address correspondence to S.B.N. (e-mail: borge001@mc.duke.edu).

PURPOSE: To determine if there was any difference in the ability of physicians to predict prognosis with technetium 99m (99mTc) sestamibi or 99mTc tetrofosmin in a large consecutive series of patients at high risk for coronary artery disease who underwent coronary angiography.

MATERIALS AND METHODS: This study included 1,818 consecutive patients who underwent a rest and stress single photon emission computed tomographic (SPECT) examination with either 99mTc sestamibi (n = 915) or 99mTc tetrofosmin (n = 903) and cardiac catheterization. A clinical index was generated and consisted of clinical and demographic variables. Information concerning death, cardiovascular death, and nonfatal myocardial infarction was 93% complete during the 1.5-year study period. Cox proportional hazards models were generated to help determine the incremental contribution of SPECT sum stress score (SSS) and the imaging agent variable to the clinical index.

RESULTS: Exercise was used for stress testing in 473 (52%) patients who received 99mTc tetrofosmin and 519 (57%) patients who received 99mTc sestamibi (P = .06). Cardiovascular death or myocardial infarction occurred in 130 patients. Resulting P values for {chi}2 differences between models for the end points of (a) death from any cause, (b) cardiovascular death, and (c) cardiovascular death or myocardial infarction showed that SSS combined with clinical index was a significantly better model than adjusting for only baseline characteristics (P = .001, P < .001, P = .004, respectively). Incremental addition of either 99mTc tetrofosmin or 99mTc sestamibi to those models containing SSS and the clinical index did not show further significant improvement (P = .87, P = .88, and P = .26 for death from any cause, cardiovascular death, and cardiovascular death or myocardial infarction, respectively).

CONCLUSION: This study shows that the type of clinically available 99mTc-labeled myocardial perfusion agents should not affect interpretation of results for risk stratification and prognostic assessment.

© RSNA, 2004

Index terms: Coronary vessels, diseases • Coronary vessels, radionuclide studies, 54.1217 • Coronary vessels, SPECT, 54.12162 • Radionuclides, comparative studies, 54.12162




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