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CLINICAL STUDY: CORONARY ARTERY DISEASE

No difference in cardiac event-free survival between positron emission tomography-guided and single-photon emission computed tomography-guided patient management

A prospective, randomized comparison of patients with suspicion of jeopardized myocardium

Hans-Marc J. Siebelink, MD^*, Paul K. Blanksma, MD, PhD^*, Harry J. G. M. Crijns, MD, PhD^*, Jeroen J. Bax, MD, PhD, Ad J. van Boven, MD, PhD^*, Tsjerk Kingma, MSc, D. Albertus Piers, MD, PhD, Jan Pruim, MD, PhD^||, Piet L. Jager, MD, PhD, Willem Vaalburg, PhD^|| and Ernst E. van der Wall, MD, PhD, FACC

^* Thorax Center, Department of Cardiology, Groningen University Hospital, Groningen, Netherlands
Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
Trial Coordination Center, Groningen University Hospital, Groningen, Netherlands
Department of Nuclear Medicine, Groningen University Hospital, Groningen, Netherlands
^|| PET Center, Groningen University and Groningen University Hospital, Groningen, The Netherlands

Manuscript received March 9, 2000; revised manuscript received June 28, 2000, accepted September 29, 2000.

Reprint requests and correspondence: Dr. Hans-Marc J. Siebelink, Thorax Center, Department of Cardiology, University Hospital Groningen, Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
H.J.Siebelink{at}thorax.azg.nl

OBJECTIVES

We sought to prospectively compare nitrogen-13 (¹³N)-ammonia/¹⁸fluorodeoxyglucose (¹⁸FDG) positron emission tomography (PET)–guided management with stress/rest technetium-99m (^99mTc)-sestamibi single-photon emission computed tomography (SPECT)–guided management.

BACKGROUND

Patients with evidence of jeopardized (i.e., ischemic or viable) myocardium may benefit from revascularization, whereas patients without it should be treated with drugs. Both PET and SPECT imaging have been proven to delineate jeopardized myocardium. When patient management is based on identification of jeopardized myocardium, it is unknown which technique is most accurate for long-term prognosis.

METHODS

In a clinical setting, 103 patients considered for revascularization with left ventricular wall motion abnormalities and suspicion of jeopardized myocardium underwent both PET and SPECT imaging. The imaging results were used in a randomized fashion to determine management (percutaneous transluminal coronary angioplasty [PTCA], coronary artery bypass graft surgery [CABG] or drug treatment). Follow-up for cardiac events (cardiac death, myocardial infarction and revascularization) was recorded for 28 ± 1 months. The study was designed to have a power of 80% to detect a 20% difference in the event rate between PET- and SPECT-based management.

RESULTS

Management decisions in 49 patients randomized to PET (12 who had PTCA, 14 CABG and 23 drug therapy) were comparable with 54 patients randomized to SPECT (15 who had PTCA, 13 CABG and 26 drug therapy). In terms of cardiac event-free survival, no differences between PET and SPECT were observed (11 vs. 13 cardiac events for PET and SPECT, respectively; p = NS by the Kaplan-Meier statistic).

CONCLUSIONS

No difference in patient management or cardiac event-free survival was demonstrated between management based on ¹³N-ammonia/¹⁸FDG PET and that based on stress/rest ^99mTc-sestamibi SPECT imaging. Both techniques may be used for management of patients considered for revascularization with suspicion of jeopardized myocardium.

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   ECG = electrocardiogram   18FDG = 18fluorodeoxyglucose   13N = nitrogen-13   PET = positron emission tomography   PTCA = percutaneous transluminal coronary angioplasty   SPECT = single-photon emission computed tomography   99mTc = technetium-99m   201Tl = thallium-201

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