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Radionuclide myocardial perfusion imaging in predischarge risk stratification of medically treated patients with non-ST elevation acute coronary syndrome

Rabih R Azar, MD, MSc, FACC
Gary V Heller, MD, PhD, FACC, MASNC
Section Editor
Jeroen J Bax, MD, PhD
Deputy Editor
Brian C Downey, MD, FACC


The use of antithrombotic and anti-ischemic medications has markedly improved the short-term outcome in patients with non-ST elevation acute coronary syndrome (NSTEACS). At present, almost all patients with NSTEACS are managed with early cardiac catheterization and, if appropriate, revascularization. (See "Coronary angiography and revascularization for unstable angina or non-ST elevation acute myocardial infarction".)

A minority of patients with NSTEACS are at low short-term risk [1] and can be treated medically since they may not benefit from revascularization [2]. This is also true for an occasional patient at intermediate risk [3]. However, some of these patients have ongoing ischemia and may develop new coronary events after hospital discharge. (See "Risk factors for adverse outcomes after non-ST elevation acute coronary syndromes".)

The possible value of radionuclide myocardial perfusion imaging in risk stratification of medically treated patients with NSTEACS will be reviewed here. Previous studies of such patients, performed before the widespread use of early revascularization, illustrated the persistent risk following medical therapy:

In the TIMI III registry, the incidence of MI or cardiac death at six week follow-up was 3.2 and 3.1 percent, respectively [4].

In the TIMI IIIB trial, the one year non-fatal MI and cardiac death rate were 8.8 and 4.3 percent, respectively [5].


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Literature review current through: Jul 2017. | This topic last updated: Dec 19, 2014.
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