Screening asymptomatic patients post PCI with myocardial perfusion imaging

Excerpt

A 58-year-old man came to clinic for routine follow-up. He had a stent placed in his obtuse marginal artery 5 years ago with no cardiac events since then. His risk factors include smoking and obesity (body mass index of 34 kg/m²). He was not diabetic. He has been taking his medications regularly since his PCI but continued to smoke and did not lose any weight. His medications included: Aspirin 100 mg daily, atorvastatin 20 mg daily, and bisoprolol 5 mg daily. Blood tests results showed: Fasting glucose 107 mg/dL, creatinine 0.8 mg/dL, cholesterol 159 mg/dL, LDL 112 mg/dL, HDL 40 mg/dL, and triglycerides 100 mg/dL. He was completely asymptomatic and categorically denied any symptoms of angina or dyspnea. He just came back from a vacation where he walked on average 8–10 km daily with no symptoms. He was referred for an exercise myocardial perfusion nuclear scan. He exercised for 9 min, achieved a peak heart rate of 142 beats/minute (87% of maximal predicted for age) and a maximal workload of 9.4 METS. At peak exercise, he developed 1–2 mm ST segment depressions in leads II, III, avF, and 2 mm ST segment elevation in lead aVR (Figure 1). The myocardial perfusion images showed a large reversible perfusion defect in the anterior, anteroseptal, and apical wall segments (Figure 2). Coronary angiography showed a severe 90% ostial lesion in the left anterior descending artery for which he had successful PCI with stenting (Figure 3) and was discharged home in stable condition.

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