Data of coronary angiography and normal stress myocardial perfusion scintigraphy

Irena Milvidaitė^{1, 2}, Ilona Kulakienė³, Nemira Jurkienė³, Leonarda Linonienė², Laima Gugienė², Janina Kanaporienė², Dalia Lukšienė¹, Ramūnas Navickas^{1, 2}

¹Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, ²Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, ³Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania

Key words: chest pain; bicycle stress test; myocardial perfusion scintigraphy; angiography.

Summary. Objective. To determine informativity of clinical variables in predicting significant coronary artery disease in patients with chest pain and normal stress myocardial perfusion scintigraphy.

Material and methods. This study was a retrospective analysis of data of coronary angiography performed in 84 patients with chest pain and normal stress myocardial perfusion scintigraphy during 2000–2007. Single-photon emission computed tomography was performed following a one-day protocol (stress-rest). A 5-point (0–4) scoring system in a 20-segment model was used for interpretation of results. Myocardial perfusion was considered normal if the sum of stress scores was 0 to 3.

Results. High pretest probability and informative exercise-terminating criteria were documented in 25% and 45.2% of patients, respectively. Significant coronary artery disease (stenosis ≥75%) was determined in 26 (31%) patients with normal myocardial perfusion scintigraphy: 15 (17.9%) patients had coronary artery disease of a single vessel, 5 (6%) of two vessels, and 6 (7.1%) of three vessels.

Univariate logistic regression analysis showed that patients with typical angina and high pretest probability were more likely to have significant stenosis of one to three arteries (odds ratios, 3.8; P=0.008 and 3.43; P=0.023, respectively). Three-vessel disease was more often documented in patients with typical angina (odds ratio, 11.2; P=0.009), high pretest probability (odds ratio, 7.93; P=0.018), and signs of ischemia during exercise test (odds ratio, 6.4; P=0.037).

Conclusion. Patients with typical angina, high pretest probability, and signs of ischemia during exercise test have an increased probability of having significant coronary artery disease despite normal stress myocardial perfusion scintigraphy; therefore, this group of patients should undergo coronary angiography.

Correspondence to I. Milvidaitė, Institute of Cardiology, Me­di­cal Academy, Lithuanian University of Health Sciences, Suki­lėlių 17, 50161 Kaunas, Lithuania. E-mail: irena.milvidaite@kmuk.lt

Received 8 July 2008, accepted 22 September 2010