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Technetium-99m (Tc-99m)-tetrofosmin is a radio isotope that has been shown to be an accurate alternative to thallium-201 for detecting coronary artery disease. However, its prognostic value is less well determined. To this end, 459 consecutive patients (mean age 58 +/- 10 years) with suspected or known coronary artery disease underwent exercise single-photon emission tomography Tc-99m-tetrofosmin scintigraphy. Follow-up, defined as the time from scanning until a soft event (revascularization procedures), a hard event (myocardial infarction and cardiac death), or patient response, lasted up to 78 months (median 38). An ischemic scintigraphic perfusion score, which takes into account both the extent and severity of reversible perfusion defects, was calculated to estimate the severity of perfusion abnormalities. Patients with normal scans were at low risk of events (yearly hard event rate 0.5% and soft event rate 0.9%). The rate of outcomes increased significantly with abnormal scans (yearly hard event rate 4.9% and soft event rate 10.3%). Statistical analysis using the Kaplan-Meyer survival curves showed a significant difference in event-free survival between patients with normal and abnormal scans. With use of Cox proportional-hazards analysis, after adjusting for prescan information, nuclear data provided incremental prognostic value for hard events (clinical and exercise data vs nuclear data; chi-square = 15.5 vs 33.4, p

Objective To evaluate the therapeutic effects of a GnRH agonist (GnRH-a), leuprolide acetate (LA) plus a pill containing ethinyl E 2 plus cyproterone acetate (CPA) in a group of women with severe hirsutism who were unresponsive to oral contraceptive (OC) therapy. Design Twenty-four patients suffering from severe hirsutism secondary to polycystic ovary disease (PCOD) were treated for 12 months with 3.75 mg IM LA every 28 days in association with 0.035 mg/d ethinyl E 2 plus 2 mg/d CPA (Diane; Schering, Berlin, Germany) for 21 d/mo. Setting Patients were recruited in the Institute of Obstetrics and Gynecology, St. Bambino Hospital, University of Catania, Catania, Italy. Hormonal assays were performed in the Hormone Laboratories of St. Bambino Hospital, University of Catania, Catania, Italy. Main Outcome Measure Every 3 months the hirsutism score was evaluated. Mean serum concentrations of LH, FSH, E 2 , total and free T, androstenedione (A), sex hormone-binding globulin (SHBG), and DHEAS were determined. Every 6 months a vaginal ultrasound examination was performed. Results In all patients after 6 and 12 months of treatment with LA plus OC, the hirsutism score improved significantly. Serum levels of LH, FSH, E 2 , total and free T, A, and DHEAS decreased significantly, whereas SHBG showed a marked increase. A significant reduction in the ovarian size was observed. Conclusion Gonadotropin-releasing hormone agonist, associated with a pill containing CPA, reduced the hirsutism in severely affected women with PCOD who are unresponsive to OC treatment alone.

P lacement of intracoronary stents during percutaneous transluminal coronary angioplasty (PTCA) decreases the morbidity of acute closure,1 the shortterm requirement for repeat revascularization by achieving a large lumen.2,3 However, stent implantation does not prevent neointimal hyperplasia, and instent restenosis still remains between 20% and 30%.4 Because of favorable initial results, stents are implanted in multivessel PTCA and as a partial revascularization in some patients, especially in elderly and high-risk patients, therefore leaving a potential source of ischemia irrespective of stent restenosis.5 Thus, in an era of cost savings, the ability to localize ischemia noninvasively and detect stent restenosis accurately is crucial in the selection of patients who require further angiographic evaluation. The effectiveness of perfusion scintigraphy in the follow-up of symptomatic and asymptomatic patients with PTCA has been defined by several studies.6–9 However, there are few prospective data regarding the usefulness of exercise perfusion imaging in patients with coronary stent implantation.10 Therefore, the aim of this study was to assess, prospectively, the accuracy of exercise technetium99m (Tc-99m)-tetrofosmin single-photon emission tomography (SPECT) for detecting restenosis after coronary stent implantation. • • • The study group consisted of 97 patients, 74 (76%) men (mean age 58 6 12 years) who, after successful stenting procedures in native coronary arteries, prospectively underwent Tc-99m-tetrofosmin tomographic myocardial scintigraphy and coronary angiography. The average interval between the stent implantation and the scintigraphic myocardial scintigraphy study was 128.4 6 41.0 days (range 88 to 191), whereas that from the scintigraphic study to coronary angiography was 57 6 25 days (range 30 to 64). Because coronary stent implantation in 10 patients was performed in 2 vascular territories, 107 stented vascular territories were included in the evaluation. Patients were excluded with stents in bypass grafts, intervening myocardial infarction, or for revascularization procedures between stent placement and scintigraphic imaging. Prior myocardial infarction ($1 month) corresponding to the stented artery was present in 51 cases. There were 31 patients (60%) with a Q-wave myocardial infarction, and 20 (40%) with a non–Q-wave myocardial infarction. Myocardial viability and residual ischemia assessed by dobutamine echocardiography was documented in most cases (89%) of infarcted territories. At angiography performed before stenting there were 38 patients (39%) with 1-vessel disease, 49 (51%) with 2-vessel disease, and 10 (10%) with 3-vessel disease. Two patients (2%) had previous coronary artery bypass graft surgery. One hundred thirty-five stents (mean length 19 6 7 mm) were implanted in 107 coronary arteries as previously described.11 The distribution of the stented arteries were: 59 (55%) left anterior descending, 20 (19%) left circumflex, and 28 (26%) right coronary artery. Stents were implanted electively in 49% of patients, for suboptimal PTCA in 30% and in bailout due to dissection or vessel closure in 21%. The mean stenosis before stenting was 85 6 12% and after stenting 8 6 7%. Stenting was performed as complete revascularization in 51 patients (53%) and as partial revascularization in the remaining 46 patients (47%). Treadmill testing was performed with the modified Bruce protocol after appropriate pharmacologic washout and according to general standards. Patients underwent 2-day SPECT scintigraphy using Tc-99mtetrofosmin. Representative sections composed of 3 short-axis sections (apical, midventricular, and basal), and of the midventricular vertical long axis combined to assess apical segments, were selected for analysis as described by Garcia et al.12 A 4-point scoring system for segmental uptake of Tc-99m-tetrofosmin was used in which 0 5 normal, 1 5 mildly reduced, 2 5 moderately reduced, and 3 5 severely decreased uptake. Patterns of perfusion defects were separately determined in each segment for rest and stress studies as previously described.13 Defect extension and severity were separately analyzed by 2 observers blinded to each other’s readings. Of the total 832 segments scored, agreement was reached in 790 (95%), whereas in the remaining segments a split decision was resolved by consensus. Myocardial segments were assigned to individual coronary arteries as previously described.13 The observers had knowledge of the vessel of stent implantation but were unaware of the results of the control coronary angiography or the results of exercise testing and clinical findings. Coronary artery stenosis was assessed specifically by 2 experienced cardiologists by means of manual calipers without knowledge of exercise scintigraphic study results. Significant disease From the Institute of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy. Dr. Galassi’s address is: Via Antonello da Messina 75, Acicastello 95021, Catania, Italy. E-mail: argal @ ctonline.it. Manuscript received August 6, 1999; revised manuscript received and accepted December 14, 1999.