Myocardial Perfusion Abnormalities Early (12–24 h) after Coronary Stenting or Balloon Angioplasty: Implications Regarding Pathophysiology and Late Clinical Outcome.

Jaffe, Ronen; Haim, Simona Ben; Karkabi, Basheer; Front, Avi; Gips, Sara; Weisz, Giora; Khader, Nader; Merdler, Amnon; Flugelman, Moshe Y.; Halon, David A.; Lewis, Basil S.

Objective: We prospectively examined the prevalence of reversible perfusion defects on very early (12–24 h) thallium-201 single photon emission computed tomography (SPECT) scintigraphy after angiographically successful percutaneous coronary intervention (PCI) by stenting and/or stand-alone balloon angioplasty and the predictive value of these defects for late target lesion revascularization (TLR). Patients and Methods: 83 consecutive patients undergoing PCI for 88 lesions (38 balloon angioplasties, 50 stents) underwent very early (12–24 h) SPECT thallium-201 scintigraphy at rest and following administration of 0.7 mg/kg intravenous dipyridamole after PCI. Univariate and multivariate clinical, procedural and scintigraphic correlates of target lesion revascularization during long-term follow-up were examined. Results: Coronary stenting achieved a larger immediate post-PCI minimal luminal dimension (2.7 ± 0.4 vs. 2.1 ± 0.4 mm, p < 0.001) and less residual stenosis (4 ± 12 vs. 19 ± 11%, p < 0.001) than stand-alone balloon angioplasty. Nonetheless, early reversible perfusion defects were similarly present in the territory supplied by 36% of stented lesions and 32% of lesions treated by balloon angioplasty (NS). Of 81 lesions (76 patients) available for long-term clinical follow-up, TLR was performed in 11% of the stent group and 14% of the balloon angioplasty group (NS). By multivariate logistic regression analysis, diabetes mellitus was the only predictor of late TLR (p < 0.05). The type of intervention (balloon or stent) predicted neither early perfusion defects nor late TLR. Conclusions: Early 201-thallium SPECT scintigraphy was abnormal in a third of patients treated by stand-alone balloon angioplasty or by stent placement. The very early SPECT scintigraphic findings did not differentiate between balloon and stent and did not predict late TLR.Copyright © 2002 S. Karger AG, Basel

MYOCARDIAL reperfusion complications; TRANSLUMINAL angioplasty; SURGICAL stents; MYOCARDIAL revascularization

Cardiology, 2002, Vol 98, Issue 1/2, p60

0008-6312

Academic Journal

10.1159/000064680