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VIEWPOINT

Myocardial perfusion imaging following percutaneous coronary intervention

the importance of restenosis, disease progression, and directed reintervention

^* Division of Cardiology, Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, New York, USA

Manuscript received April 25, 2003; revised manuscript received August 25, 2003, accepted September 9, 2003.

^* Reprint requests and correspondence: Dr. Kenneth N. Giedd, Division of Cardiology, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, New York 10032, USA.
kng1{at}columbia.edu

Percutaneous coronary intervention (PCI) has become a mainstay in the treatment of patients with coronary artery disease. Currently, more than one million coronary angioplasty and stent implantation procedures are performed annually. Although increasingly complex lesions and higher risk patients are being successfully treated percutaneously, restenosis and disease progression continue to cause significant morbidity. Restenosis occurs in approximately one-third of patients, one-half of who remain asymptomatic, while disease progression occurs at rates approaching 7% per year. Despite technological advances, unadjusted mortality rates have actually increased since the mid-1980s, and the current annual risk of a major adverse cardiac event following PCI is 5% to 7%. Although randomized clinical trials are needed to more definitively show a benefit, when performed six or more months following PCI, myocardial perfusion imaging reliably identifies patients most at risk of a poor long-term outcome. Directed reintervention can have a salutary impact on the prognosis of these patients. In view of recent data showing a positive impact of imaging and reintervention in patients after PCI, current guidelines should be reassessed.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   CAD = coronary artery disease   ECG = electrocardiography   ISR = in-stent restenosis   MI = myocardial infarction   MPI = myocardial perfusion imaging   PCI = percutaneous coronary intervention   PTCA = percutaneous transluminal coronary angioplasty   SPECT = single-photon emission computed tomography

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