Usefulness of Myocardial Perfusion SPECT after Percutaneous Coronary Intervention (PCI)

경피적 관상동맥 중재술(Percutanerous Coronary Intervention; PCI) 후 심근 관류 SPECT의 유용성

  • Lee, Jong-Jin (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Lee, Dong-Soo (Department of Nuclear Medicine, Seoul National University College of Medicine)
  • 이종진 (서울대학교 의과대학 핵의학교실) ;
  • 이동수 (서울대학교 의과대학 핵의학교실)
  • Published : 2005.04.30


As the indication of percutaneous coronary intervention (PCI) has expanded to the more difficult and complicated cases, frequent restenosis is still expected after PCI. According to AHA/ACC guideline of the present time, routine use of myocardial perfusion single photon emission tomography (SPECT) is not recommended after coronary intervention, but symptom itself or exercise EKG is not enough for the detection of restensis or for the prediction of event-free survival. In high risk and/or symptomatic subjects, direct coronary angiography is required myocardial perfusion SPECT could detect restenosis in 79% of the patients if performed 2 to 9 months after PCI. Reversible perfusion decrease in the myocardial perfusion SPECT is known to be the major prognostic indicator of major adrerse cardiac event in PCI patients and also the prognosis is benign in the patients without reversible perfusion decrease. Though the cumulated specificity is 79% in the literature and optimal timing of myocardial perfusion SPECT is in controversy, SPECT is recommended even in asymptomatic patients at 3 to 9 months after PCI. Considering the evidences recently reported in the literature, myocardial perfusion SPECT is useful for risk stratification and detection of coronary artery restenosis requiring re-intervention in the asymptomatic patients after PCI.


  1. Smith SC Jr, Dove JT, Jacobs AK, Kennedy JW, Kereiakes D, Kern MJ, et al. ACC/AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines)--executive summary. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty). J Am Coll Cardiol 2001;37: 2215-39
  2. Giedd KN, Bergmann SR. Myocardial perfusion imaging following percutaneous coronary intervention: the importance of restenosis, disease progression, and directed reintervention. J Am Coll Cardiol 2004;43:328-36
  3. Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 2004;110:e340-437
  4. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 2003;42:1318-33
  5. Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, et al. ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol 1997;30:260-311
  6. Marie PY, Danchin N, Karcher G, Grentzinger A, Juilliere Y, Olivier P, et al. Usefulness of exercise SPECT-thallium to detect asymptomatic restenosis in patients who had angina before coronary angioplasty. Am Heart J 1993;126:571-7
  7. Zellweger MJ, Weinbacher M, Zutter AW, Jeger RV, Mueller- Brand J, Kaiser C, et al. Long-term outcome of patients with silent versus symptomatic ischemia six months after percutaneous coronary intervention and stenting. J Am Coll Cardiol 2003;42: 33-40
  8. Cottin Y, Rezaizadeh K, Touzery C, Barillot I, Zeller M, Prevot S, et al. Long-term prognostic value of $^{201}Tl $single-photon emission computed tomographic myocardial perfusion imaging after coronary stenting. Am Heart J 2001;141:999-1006
  9. Alazraki NP, Krawczynska EG, Kosinski AS, DePuey EG 3rd, Ziffer JA, Taylor AT Jr, et al. Prognostic value of thallium-201 single-photon emission computed tomography for patients with multivessel coronary artery disease after revascularization (the Emory Angioplasty versus Surgery Trial [EAST]) Am J Cardiol 1999;84:1369-74
  10. Acampa W, Petretta M, Florimonte L, Mattera A, Cuocolo A. Prognostic value of exercise cardiac tomography performed late after percutaneous coronary intervention in symptomatic and symptom-free patients. Am J Cardiol 2003;91:259-63
  11. Mishra JP, Iskandrian AE. Stress myocardial perfusion imaging after coronary angioplasty. Am J Cardiol 1998;81:766-9
  12. Cingi E, Temiz NH, Yildirim N, Timurkaynak T, Cengel A, Unlu M. Detection of stent restenosis in single vessel CAD: comparison of 201Tl and gated $^{99m}Tc$-MIBI SPECT. Nucl Med Commun 2004;25:479-86
  13. Miller DD, Verani MS. Current status of myocardial perfusion imaging after percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 1994;24:2606
  14. Wilson RF, Johnson MR, Marcus ML, Aylward PE, Skorton DJ, Collins S, et al. The effect of coronary angioplasty on coronary flow reserve. Circulation 1988;77:873-85
  15. Uren NG, Crake T, Lefroy DC, de Silva R, Davies GJ, Maseri A. Delayed recovery of coronary resistive vessel function after coronary angioplasty. J Am Coll Cardiol 1993;21:612-21
  16. Versaci F, Tomai F, Nudi F, Gaspardone A, De Fazio A, Ciavolella M, et al. Differences of regional coronary flow reserve assessed by adenosine thallium-201 scintigraphy early and six months after successful percutaneous transluminal coronary angioplasty or stent implantation. Am J Cardiol 1996;78:1097-102