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Long-term outcome of patients with silent versus symptomatic ischemia six months after percutaneous coronary intervention and stenting

Michael J. Zellweger, MD^*,*, Markus Weinbacher, MD^*, Andreas W. Zutter, MD^*, Raban V. Jeger, MD^*, Jan Mueller-Brand, MD, Christoph Kaiser, MD^*, Peter T. Buser, MD, FACC^* and Matthias E. Pfisterer, MD, FACC^*

^* Department of Cardiology, Basel, Switzerland
Nuclear Medicine, University Hospital, Basel, Switzerland.

View larger version (12K): [in a new window]   Figure 1 Flow chart of patients (pts).

View larger version (12K): [in a new window]   Figure 2 Receiver-operating characteristic curve for the discrimination between silent and symptomatic ischemia. Note that the best discrimination of silent versus symptomatic ischemia was found with a summed difference score (SDS) of 4.

View larger version (15K): [in a new window]   Figure 3 Kaplan-Meier event-free survival curves by summed difference score (SDS) categories. Patients with an SDS of 0 (n = 242) had significantly lower event rates than patients with an SDS of 1 to 4 (n = 49; p = 0.03); these patients had significantly lower event rates than patients with SDS >4 (n = 16; p = 0.005). Note the significant differences in outcome between patients with no, mild, and moderate to severe ischemia, as defined by SDS. MPS = myocardial perfusion SPECT.

View larger version (15K): [in a new window]   Figure 4 Kaplan-Meier event-free survival curves by symptomatic status. Patients without ischemia (n = 242) had significantly lower event rates than patients with silent (n = 44) or symptomatic ischemia (n = 21; p = 0.006 and p < 0.0001, respectively); patients with silent ischemia tended to have lower event rates than patients with symptomatic ischemia (p = 0.12). MPS = myocardial perfusion SPECT.

View larger version (44K): [in a new window]   Figure 5 Incremental value of nuclear testing in the evaluation of long-term prognosis. *#Significant increase in global chi-square (*p = 0.001, #p = 0.002). ECG = electrocardiogram; SDS = summed difference score.