Prognostic significance of ST-segment depression during adenosine perfusion imaging

• Published in: The American heart journal Vol. 130; no. 1; pp. 58 - 66
• Main Authors: Marshall, Erik S., Raichlen, Joel S., Kim, Sung M., Intenzo, Charles M., Sawyer, David T., Brody, Eric A., Tighe, Dennis A., Park, Chan H.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.07.1995; Elsevier
• Subjects: Adenosine - administration & dosage; Aged; Biological and medical sciences; Cardiology. Vascular system; Chi-Square Distribution; Coronary Disease - diagnosis; Coronary heart disease; Coronary Vessels - diagnostic imaging; Electrocardiography - drug effects; Electrocardiography - methods; Electrocardiography - statistics & numerical data; Exercise Test - methods; Exercise Test - statistics & numerical data; Female; Follow-Up Studies; Heart; Humans; Likelihood Functions; Male; Medical sciences; Middle Aged; Prognosis; Proportional Hazards Models; Radionuclide Imaging; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Time Factors; Human; Electrodiagnosis; Adenosine; Purine nucleoside; Prognosis; Vasodilator agent; Intravenous administration; Coronary artery; Electrocardiography; Cardiovascular disease; ST depression; Coronary heart disease
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(95)90236-8

To determine the significance of ST-segment depression during adenosine perfusion imaging for predicting future cardiac events, 188 patients with interpretable electrocardiograms were assessed 1 to 3 years (mean 21.5 ± 6.6 months) after adenosine testing. At least 1 mm of ST-segment depression was observed in 32 (17%) patients, with ≥2 mm of ST-segment depression in 10 (5.3%). Thirty-seven cardiac events occurred during the study period: 2 cardiac deaths, 5 nonfatal myocardial infarctions, 6 admissions for unstable angina, and 24 revascularizations. Univariate predictors of events were a history of congestive heart failure, previous non—Q-wave myocardial infarction, previous coronary angioplasty, use of antianginal medication, ST-segment depression during adenosine infusion (particularly ≥2 mm), any reversible perfusion defect, transient left ventricular cavity dilation, and the severity of perfusion defects. Multivariate analysis identified ≥2 mm ST-segment depression as the most significant predictor of cardiac events (relative risk [RR] = 6.5; p = 0.0001). Other independent predictors of events were left ventricular dilation (RR = 3.8; p = 0.002), previous coronary angioplasty (RR = 3.3; p = 0.001), a history of non—Q-wave myocardial infarction (RR = 2.3; p = 0.01), and the presence of any reversible defect (RR = 2.0; p = 0.05). We conclude that ST-segment depression occurs uncommonly during adenosine infusion, but the presence of ≥2 mm of ST-segment depression is an independent predictor of future cardiac events and provides information in addition to that obtained from clinical variables and the results of adenosine perfusion imaging.