Abstract 11247: Single Photon Emission Computed Tomography Stress Myocardial Perfusion Imaging at 1-Year Following Uneventful CABG Predicts Long-Term Risk of Death and Heart Failure.

Introduction: Among asymptomatic patients, the value of stress imaging at 1 year following successful CABG for predicting long-term adverse outcomes has not been shown. Hypothesis: Among patients enrolled in a VA cooperative study to detect graft patency at 1-year post-CABG, SPECT-MPI predicts long-term risk of adverse cardiovascular events. Methods: At a single center participating in a VA Cooperative Study on long-term graft patency, enrolled patients underwent both coronary angiography and stress imaging at 1-year following CABG. Stress imaging was performed on the same day as the coronary angiogram and interpretation was blinded to the coronary angiogram. SPECT results were categorized according to the size of the perfusion defect, and graded as none, small or moderate to large. Results of the graft studies were categorized as either none or 1 or more grafts with a significant stenosis. Long-term adverse end-points include the composite of death and new diagnosis of heart failure. Results: Eighty-four participants underwent SPECT-MPI and coronary angiogram at one-year post-CABG. Graft disease was identified in 39 patients involving 56 of 251 potential graft sites (22%) and compared to those individuals with no graft disease, did not predict long-term adverse outcomes (31% vs 38% p=0.51). Those individuals with a poor long-term outcome failed to increase their LVEF at 1-year compared with pre-CABG (Figure 1). In addition, a moderate or larger sized defect on SPECT (N=18) was associated with a significant increased risk of adverse outcomes compared with those individuals with either no defect (N=57) or a small defect (N=27) (56% Versus 30%; Odds Ratio = 1.8, P<0.05) (Figure 2). Conclusions: Among asymptomatic patients at 1-year following CABG, assessment of LVEF and defect size with SPECT-MPI was a predictor of long-term risk of death and heart failure. Use of stress imaging, as a means of risk-stratification following bypass surgery, even among those patients without clinical symptoms, may have value. [ABSTRACT FROM AUTHOR]