Evaluation of Need for Implantable Cardioverter-Defibrillator by Thallium-201 Scintigraphy Among Japanese Patients With Prior Myocardial Infarction

• Published in: Circulation Journal Vol. 83; no. 1; pp. 56 - 66
• Main Authors: Okada, Masato, Kashiwase, Kazunori, Hirata, Akio, Nishio, Mayu, Takeda, Yasuharu, Nemoto, Takayoshi, Amiya, Ryohei, Ueda, Yasunori, Higuchi, Yoshiharu, Yasumura, Yoshio
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25.12.2018
• Subjects: Appropriate ICD therapy; Arrhythmic death; Implantable cardioverter-defibrillator; Thallium-201 scintigraphy; Appropriate ICD therapy; Thallium-201 scintigraphy; Arrhythmic death; Implantable cardioverter-defibrillator
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-17-1436

Background: Identifying who among current Japanese patients with prior myocardial infarction (MI) would benefit from an implantable cardioverter-defibrillator (ICD) is imperative. Accordingly, this study seeks to determine whether single-photon emission computed tomography (SPECT) can help identify such patients. Methods and Results: This retrospective study enrolled 60 consecutive patients with prior MI who underwent stress thallium-201 SPECT and ICD implantation from February 2000 to October 2014. Occurrence of arrhythmic death and/or or appropriate ICD therapy, defined as shock or antitachycardia pacing for ventricular fibrillation or tachycardia, was identified until November 2016. During the median follow-up interval of 6.6 years, 18 (30%) patients experienced arrhythmic death and/or appropriate ICD therapy. Multivariate Cox proportional hazard regression analysis revealed that the summed stress score (SSS) [hazard ratio (HR)=1.14; P=0.005] and left ventricular ejection fraction (LVEF) at rest (HR=0.92; P=0.038) were significantly associated with the occurrence of arrhythmic events. Patients with SSS ≥21 and LVEF ≤30%, which were determined to be the best cutoff points, had significantly higher incidence of the arrhythmic events than the other patients (64% vs. 11%; HR=7.18; log-rank P=0.001). Conclusions: SSS using stress thallium-201 SPECT in combination with LVEF can help determine the need for ICD therapy among current Japanese patients with prior MI.