Correlation of current myocardial perfusion imaging and previous coronary angiography to avert the need for repeat intervention - A case report

Abstract

Introduction: Evaluation of chest pain in an individual with prior coronary artery bypass graft (CABG) procedures can be complex. Stress myocardial perfusion imaging (MPI) demonstrates reasonable sensitivity for detection of ischemia following bypass grafting [1] but often requires multi-modality imaging correlation for knowledge of graft anatomy.

Case and outcome: We describe the findings of a reversible perfusion defect on myocardial perfusion scintigraphy in a person post-CABG. This was interpreted in combination with findings of coronary angiography, thereby identifying ischemia in a native un-grafted vessel territory and influencing management strategy.

Discussion: Myocardial perfusion scintigraphy is a sensitive technique for evaluation of inducible ischemia. It provides information on the extent and severity of ischemia. Integrating the knowledge of changes on coronary angiography with MPI provides a comprehensive picture that can guide management decisions, as in our case.

Conclusion: Correlation of structural and functional imaging findings may be extremely helpful for management of patients with myocardial ischemia post-CABG.

Keywords: Coronary angiography; Dipyridamole stress; Emission-computed; Graft occlusion; MPI; Myocardial perfusion imaging / methods; Single-photon; Tomography; Vascular / diagnostic imaging.