The Journal of Thoracic and Cardiovascular Surgery
Volume 136, Issue 1 , Pages 46-51, July 2008

Stress cardiac single-photon emission computed tomographic imaging late after coronary artery bypass surgery for risk stratification and estimation of time to cardiac events

  • Wanda Acampa, MD, PhD

      Affiliations

    • Institute of Biostructures and Bioimages, National Council of Research, Naples, Italy
    • Department of Biomorphological and Functional Sciences, University Federico II, Naples, Italy
    • ,
  • Mario Petretta, MD

      Affiliations

    • Department of Internal Medicine, Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy
    • ,
  • Laura Evangelista, MD

      Affiliations

    • SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy
    • ,
  • Gianantonio Nappi, MD

      Affiliations

    • Department of Cardiothoracic Surgery, Second University, Naples, Italy
    • ,
  • Luca Luongo, MD

      Affiliations

    • Department of Biomorphological and Functional Sciences, University Federico II, Naples, Italy
    • ,
  • Maria Piera Petretta, MD

      Affiliations

    • Department of Internal Medicine, Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy
    • ,
  • Alberto Cuocolo, MD

      Affiliations

    • Institute of Biostructures and Bioimages, National Council of Research, Naples, Italy
    • Department of Biomorphological and Functional Sciences, University Federico II, Naples, Italy
    • SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy
    • Corresponding Author InformationAddress for reprints: Alberto Cuocolo, MD, Department of Biomorphological and Functional Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy.

Received 18 July 2007; received in revised form 10 September 2007; accepted 4 October 2007. published online 08 May 2008.

Objective

We assessed predictors and temporal characteristics of cardiac risk in patients undergoing stress single-photon emission computed tomography after coronary artery bypass grafting.

Methods

Stress cardiac tomography was performed in 362 patients 5 years after coronary artery bypass grafting. Cardiac death and myocardial infarction were considered as events. Cox proportional hazards analysis was used to identify predictors of events and parametric survival analysis to predict time to events.

Results

During a median follow-up of 27 months, 22 cardiac events occurred (6.1% cumulative event rate). At multivariable Cox analysis, ischemia at cardiac tomography (hazards ratio 3.7, 95% confidence interval 1.5–9.1; P = .004), and diabetes (hazards ratio 3.6, 95% confidence interval 1.5–8.5; P = .006) resulted in independent predictors of events. Event-free survival was 96% in patients with normal cardiac tomography, 86% in those with abnormal tomography without ischemia, and 70% in those with (log–rank 10.6, P for trend = .008). The parametric survival model revealed that the cardiac risk was greater for all time intervals and accelerated more over time in patients with ischemia than in those without (χ2 21.4, P < .0001). Patients without diabetes and normal cardiac tomography remained below a defined risk level (5%) for the entire follow-up period.

Conclusion

Stress cardiac tomography performed 5 years after coronary artery bypass grafting is useful to characterize the risk of cardiac events and its temporal variation. Parametric survival model estimates the predicted time to risk and the level of risk at specific time intervals after coronary artery bypass grafting.

Abbreviations and Acronyms: CABG, coronary artery bypass grafting, CI, confidence intervals, SPECT, single-photon emission computed tomography

CTSNet classification: 18, 23

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 Stress cardiac tomography performed 5 years after CABG is useful to characterize the risk of cardiac events and its temporal variation. A parametric survival model estimates the predicted time to risk and the level of risk at specific time intervals after CABG.

PII: S0022-5223(07)01653-4

doi:10.1016/j.jtcvs.2007.10.011

The Journal of Thoracic and Cardiovascular Surgery
Volume 136, Issue 1 , Pages 46-51, July 2008

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