Predicción de lesiones coronarias significativas mediante perfusión miocárdica con SPECT. Resultados de un centro de referencia nacional en Lima-Perú

Luisa S. Talledo-Paredes; Delia M.T. Guerrero-Ramírez; Aurelio Mendoza-Paulini; Zoila Rodríguez-Urteaga; Daniel Angulo-Poblete; Josías C. Ríos-Ortega

doi:10.47487/apcyccv.v3i2.222

Authors

Luisa S. Talledo-Paredes Servicio de Ayuda al Diagnóstico y Tratamiento, Instituto Nacional Cardiovascular, EsSalud. Lima. Perú; Programa de Maestría de Investigación y Docencia en Salud, Universidad Nacional de San Marcos. Lima, Perú. https://orcid.org/0000-0002-7225-7695
Delia M.T. Guerrero-Ramírez Servicio de Ayuda al Diagnóstico y Tratamiento. Instituto Nacional Cardiovascular. EsSalud. Lima. Perú. https://orcid.org/0000-0001-9316-6664
Aurelio Mendoza-Paulini Servicio de Ayuda al Diagnóstico y Tratamiento, Instituto Nacional Cardiovascular, EsSalud. Lima. Perú. https://orcid.org/0000-0001-8091-5179
Zoila Rodríguez-Urteaga Servicio de Ayuda al Diagnóstico y Tratamiento, Instituto Nacional Cardiovascular, EsSalud. Lima. Perú. https://orcid.org/0000-0002-6565-8917
Daniel Angulo-Poblete Programa de Maestría de Investigación y Docencia en Salud, Universidad Nacional de San Marcos. Lima, Perú https://orcid.org/0000-0002-3885-9924
Josías C. Ríos-Ortega Servicio de cirugía cardiovascular, Instituto Nacional Cardiovascular, EsSalud. Lima. Perú. https://orcid.org/0000-0002-4396-7954

DOI:

https://doi.org/10.47487/apcyccv.v3i2.222

Keywords:

Perfusión Miocárdica, Infarto de Miocardio, Perú

Abstract

Objective. To determine the discriminative capacity of myocardial perfusion with single photon emission tomography (SPECT) to predict coronary obstructions by coronary angiography. To determine mortality and major cardiovascular events at follow-up. Materials and methods. Retrospective observational study with clinical follow-up in patients undergoing SPECT and then coronary angiography. We excluded patients with myocardial infarction and percutaneous and/or surgical revascularization in the previous 6 months. Results: 105 cases were included in the study. The most commonly used SPECT protocol was pharmacological (70%). Patients with perfusion defect ≥10% of total ventricular mass (TVM) had significant coronary lesions (SCL) in 88% of cases (sensitivity 87.5% and specificity 83%). On the other hand, having ischemia ≥10% of the TVM was associated with 80% SCL (sensitivity: 72%, specificity: 65%). Clinical follow-up at 48 months evidenced that a perfusion defect ≥ 10% was predictive of major cardiovascular events (MACE) in both univariate (HR=5.3; 95%CI 1.2 - 22.2; p=0.022) and multivariate (HR= 6.1; 95%CI 1.3 - 26.9; p= 0.017) analyses. Conclusions. Having a perfusion defect ≥10% of the MVT in the SPECT study predicted with high probability and sensitivity the existence of
SCL (>80%); moreover, this group had higher MACE at follow-up.

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