Comparability of scintigraphy data with coronary angiography after surgical myocardial revascularization

Introduction. Radionuclide imaging is included in diagnostic methods after PCI and CABG in patients with symptoms, but the recommendations caution against routine testing in all asymptomatic patients after revascularization. The paper shows the results of single-photon emission computed tomography after hybrid coronary myocardial revascularization; an analysis of the sensitivity and specificity of three methods of surgical myocardial revascularization was carried out in 12 months.

Aim of the study was to determine the sensitivity and specificity of SPECT in determining coronary artery stenosis ≥ 50 % after performing three methods of surgical myocardial revascularization: CABG, PCI, and hybrid myocardial revascularization in patients with coronary artery disease and multi-vascular coronary lesion.

Material and methods. A retrospective analysis of 82 patients with stable forms of coronary artery disease who underwent myocardial revascularization for the presence of the multivascular coronary lesion was carried out. The patients were divided into three groups: the first group consisted of 40 patients who underwent CABG, the second – 29 patients after PCI, and the third – 23 patients who underwent hybrid myocardial revascularization.

Results. All patients after myocardial revascularization, on average, after 21.8±8.6 months, were hospitalized, where singlephoton emission computed tomography of the myocardium with 99mTc-technetril (SPECT) and control coronarography/ shuntography were performed. The frequency of the presence of significant stenosis during coronary angiography with a perfusion defect of ≥5 % on SPECT during exercise was 50, 50 and 33 % in the CABG, PCI, and hybrid revascularization, respectively (p=0.894). The least sensitivity of SPECT was after hybrid myocardial revascularization (20 %), while in the CABG group, the sensitivity was 71.4 % (p = 0.190). The SPECT specificity indices were much higher: in the GABG, PCI, and hybrid revascularization groups, respectively, 75.8, 79 and 88.9 % (p=0.530).

Conclusion. There is no significant relationship between the size of the defect on SPECT and coronary angiography data, regardless of the type of surgical myocardial revascularization in patients after myocardial revascularization. Detection of a perfusion defect with a load of more than 10% in SPECT after surgical myocardial revascularization is the basis for coronary angiography in order to exclude stent restenosis or shunt dysfunction, as well as progression of coronary atherosclerosis.

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