ABC | Volume 111, Nº6, December 2018

Original Article Andrade et al Prognostic Value of Myocardial Scintigraphy Arq Bras Cardiol. 2018; 111(6):784-793 Table 1 – Characteristics of the study population. Characteristics N (%) or mean ± SD Age (years), mean ± SD 66.1 ± 10 Male gender 464 (72%) Arterial hypertension 411 (64%) Dyslipidemia 378 (58%) Diabetes Mellitus 189 (29%) Previous AMI 342 (53%) Current smoking 48 (7%) Previous smoking 204 (32%) Family history of CAD 193 (30%) SD: standard deviation; CAD: coronary artery disease; AMI: acute myocardial infarction. Table 2 – Predictors of ischemia Characteristics Univariate analysis OR (95% CI) p value Multivariate analysis OR (95% CI) p value Age > 70 years 0.36 (0.65 to 1.30) 0,489 0.82 (0.55 to 1.20) 0,309 Male gender 1.13 (0.78 to 1.63) 0,515 1.35 (0.89 to 2.05) 1,155 Diabetes Mellitus 1.22 (0.85 to 1.76) 0,288 1.30 (0.88 to 1.93) 0,179 Previous AMI 2.51 (1.77 to 3.59) < 0,001 2.87 (1.60 to 5.13) < 0,001 Previous PCI by ACS 1.90 (1.36 to 2.68) < 0,001 0.71 (0.41 to 1.24) 0,229 Ejection fraction < 50% 1.52 (1.08 to 2.16) 0,018 1.61 (0.78 to 1.71) 0,454 Pharmacological stress 1.34 (0.95 to 1.89) 0,091 1.22 (0.84 to 1.78) 0,294 MPS indication, incomplete revascularization 3.43 (2,11 to 5.57) < 0,001 2.99 (1.80 to 4.98) < 0,001 AMI: acute myocardial infarction; PCI: percutaneous coronary intervention; ACS: acute coronary syndrome; MPS: myocardial perfusion scintigraphy. questionnaire. Deaths were confirmed consulting the Mortality Information System (SIM) database, and the basic cause of death was identified, and all those included in Chapter IX of the International Classification of Diseases (ICD-10), which comprises the diseases of the circulatory system, were considered cardiovascular. Patients not contacted through telephone calls were considered alive if they were not found in the SIMdatabase, but were considered as loss of follow-up in relation to the other outcomes. Primary endpoints were mortality, cardiovascular mortality, and nonfatal AMI, and surgical or percutaneous revascularization was considered a secondary endpoint. Statistical analysis The analysis was performed in the SPSS statistical package version 23.0. Categorical variables are presented as frequencies and percentages and compared using the chi-square test. Numerical variables are presented as mean and standard deviation, or median and interquartile range, according to the normal distribution pattern assessed by the Kolmogorov‑Sminorv test, and compared using Student’s t-tests or Mann-Whitney test, as appropriate. Variables with statistical significance in the univariate analysis were included in the multivariate model, using logistic regression and the COX model. Variables with significant correlations among them were excluded from the model. Survival curves of different subgroups were evaluated by the Kaplan Meier estimator and compared by the log-rank test. Statistical significance was defined as a value of p < 0.05. Results A total of 647 patients was included and mean follow‑up time was 5.2 ± 1.6 years for mortality analysis. In the analysis of the other outcomes, there was a loss of follow‑up of 18 patients and the mean follow-up time was 3.9 ± 1.5 years. The analysis of the demographic characteristics of the population, as shown in Table 1, revealed a mean age of 66.1 ± 10 years and a predominance of males. Arterial hypertension (AH) was the most frequent risk factor, followed by dyslipidemia and diabetes mellitus (DM). Fifty‑three percent had a previous history of acute myocardial infarction (AMI). The 18 patients lost at follow-up were compared to 629 contacts and no statistically significant clinical differences were observed between the two groups. The median dates for prior PCI were March 2008, and 44% were performed in the context of acute coronary syndrome (ACS). The interval between PCI and MPS was a median of 3 years, and was less than 2 years in 42% of the cases. Among the MPS indications, a control examination after PCI was the most frequent, reaching 75% of the cases. Incomplete revascularization was the second most common justification (12%), followed by preoperative evaluation (7%). The physical stress protocol was used in 59.5% of the exams. MPS were normal in 47% of patients, abnormal with no ischemia in 23%, and abnormal with ischemia in 30%. Previous AMI and incomplete revascularization as an indication of MPS were independently associated with the presence of ischemia, as shown in Table 2. During follow-up, 61 deaths were recorded, of which 27 were due to cardiovascular causes. Mortality was higher among patients with abnormal MPS without ischemia, followed by the group with abnormal MPS with ischemia, and less found in the group with normal perfusion. The annual rate of death in each group was 3.3%, 2% and 1.2% respectively. Cardiovascular mortality followed the same pattern of incidence in the groups, with annual rates of 1.4%, 0.9% and 0.5%, respectively. 786