ABC | Volume 111, Nº6, December 2018

Original Article Andrade et al Prognostic Value of Myocardial Scintigraphy Arq Bras Cardiol. 2018; 111(6):784-793 Such variations can be attributed to the use of different diagnostic definitions of pathologies. On the other hand, they may reflect the selection of populations with different severity profiles, thus with different prognostic aspects. Despite the lack of information on prior PCI, considering that only 11% of the procedures were performed before 2003, time at which drug-eluting stents were introduced, and that MPS exams were performed in a private clinic in patients with wide access to care, including 30% of diabetics, it is believed that the stents used in previous angioplasties have been almost entirely drug-eluting stents. In previous studies, patients were treated with balloon angioplasty and conventional stent implantation, 9-13 with the exception of the study by Zellweger et al. in which 69% of the participants were treated with a drug-eluting stent. 14 Such findings should be taken into account in the interpretation of outcomes, because after the advent of drug-eluting stents, there was a decrease in the incidence of early and late complications of the procedure and, consequently, in the occurrence of events. Although the current guidelines 2,5,16 do not indicate routine functional tests, especially in the period of less than 2 years in asymptomatic patients after PCI, in the present study, 42% of MPS were performed within less than 2 years after PCI, and the control examination was the most frequent indication, independent of the period. Similarly, Luca et al., 17 in an observational study including 12,380 patients undergoing PCI in Canada from 2004 to 2012, and Shah et al., 18 in a study including 21046 patients undergoing percutaneous revascularization between 2004 and 2007 in the USA, observed that 60% and 61%, respectively, underwent at least one functional test within a 2-year period. 17,18 One possible justification for functional evaluation to remain a frequent clinical practice among asymptomatic patients after PCI is the lack of robust information about the theme that defines the correct management of these patients, and the fact that the current recommendations are based on the opinion of specialists. 2,5,16 Figure 3 – Kaplan-Meier survival curve of mortality according to previous PCI-MPS interval shorter or longer than 2 years. 1.00 0.75 0.50 0.25 0.00 Cumulative survival 0 24 48 72 96 follow-up time in months Log Rank p = 0.491 PREVIOUS PCI-MPS INTERVAL < 2 years > 2 years Table 5 – Predictors of revascularization Characteristics Univariate analysis OR (95%) p value Multivariate analysis OR (95% CI) p value Age > 70 years 0.78 (0.52 to 1.16) 0,223 0.84 (0.55 to 1.28) 0,419 Diabetes Mellitus 1.30 (0.87 to 1.95) 0,198 1.38 (0.89 to 2.15) 0,145 Previous AMI 1.04 (0.71 to 1.52) 0,823 0.69 (0.45 to 1.06) 0,092 MPS indication, control 0.41 (0.27 to 0.61) 0,000 0.86 (0.46 to 1.63) 0,655 MPS indication, incomplete revascularization 4.80 (2.93 to 7.87) 0,000 3.55 (1.65 to 7.60) < 0,001 PCI-MPS Time < 2y 1.51 (1.35 to 1.75) 0,001 1.55 (1.36 to 1.83) 0,005 Ischemic defect > 3% 3.07 (2.09 to 4.64) 0,000 2.87 (1.83 to 451) < 0,001 AMI: acute myocardial infarction; MPS: myocardial perfusion scintigraphy. 789