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When to stress patients after coronary artery bypass surgery?

Risk stratification in patients early and late post-CABG using stress myocardial perfusion SPECT: implications of apppropriate clinical strategies

Michael J. Zellweger, MD^*, Howard C. Lewin, MD^*, Shenghan Lai, MD, PhD, Eric A. Dubois, MD, PhD^*, John D. Friedman, MD, FACC^*, Guido Germano, PhD, FACC^*, Xingping Kang, MD^*, Tali Sharir, MD^* and Daniel S. Berman, MD, FACC^*

^* Department of Imaging (Division of Nuclear Medicine), Medicine (Division of Cardiology), and Artificial Intelligence in Medicine Program, Cedars–Sinai Medical Center; the CSMC Burns and Allen Research Institute, and the Department of Medicine, University of California Los Angeles, School of Medicine, Los Angeles, California, USA
University of Miami, Miami, Florida, USA

View larger version (11K): [in a new window]   Figure 1 Annual cardiac death (CD) rates as a function of time and symptoms (n = 1544). p = NS for all comparisons.

View larger version (10K): [in a new window]   Figure 2 Annual cardiac death (CD) rates as a function of SSS in patients 5 and >5 years post-CABG (n = 1,544). *Statistically significant increase as a function of SSS (p = 0.049, 0.005 for 5 and >5 years, respectively. CABG = coronary artery bypass graft surgery; SSS = summed stress score.

View larger version (12K): [in a new window]   Figure 3 Early catheterization rates as a function of SSS in patients 5 and >5 years post-CABG (n = 1,707). *Statistically significant increase as a function of SSS (p < 0.001). CABG = coronary artery bypass graft surgery; SSS = summed stress score.

View larger version (7K): [in a new window]   Figure 4 Global chi-square values with respect to prescan information and nuclear variables (n = 1,544). *Significant increase of chi-square (p < 0.001).

View larger version (17K): [in a new window]   Figure 5 Global chi-square values with respect to clinical, treadmill, and nuclear variables (n = 703). *,# Significant increase of chi-square (p < 0.05).

View larger version (16K): [in a new window]   Figure 6 Outcomes (annual cardiac death rates) with optimized nuclear strategy. CABG: coronary artery bypass grafting; CD = cardiac death; EF = ejection fraction; NRS = number of non-reversible segments; SDS = summed difference score; SSS = summed stress score. *If non-viable benefit of angiography less clear.