Document Detail

Prognostic estimation of coronary artery disease risk with resting perfusion abnormalities and stress ischemia on myocardial perfusion SPECT.
MedLine Citation:
PMID:  18984451     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The extent and severity of stress ischemia are strong predictors of coronary artery disease (CAD) events. Prognosis associated with myocardial perfusion single photon emission computed tomography (MPS) abnormalities on the resting scan as it relates to stress ischemia has been incompletely described. METHODS AND RESULTS: The Myoview Prognosis Registry was a prospective consecutive series of 7849 outpatients enrolled from 5 geographically diverse centers. Patients were followed up for the occurrence of CAD events (nonfatal myocardial infarction [MI] or death related to MI, heart failure, or sudden cardiac death). Time to CAD event (n = 545) was estimated by use of univariable and multivariable Cox proportional hazards models (risk adjusted by symptoms, risk factors, and comorbid conditions). For patients with no resting defects, overall CAD event rates were 1.2%, 8%, and 10% for patients with 0% ischemic myocardium, 1% to 4.9% ischemic myocardium, and 5% ischemic myocardium or greater, respectively (P < .0001). As the percent myocardium with resting defects worsened, overall CAD event rates increased, such that for patients with 10% or more of the rest myocardium with perfusion defects, cardiovascular death or MI rates ranged from 7% to 44% (P < .0001). In a model including both the percent of the myocardium with resting defects and the percent ischemia, both were highly predictive of CAD events (P < .0001). For every 1% increase in ischemic myocardium, there was a 7% increased risk of CAD events (P < .0001). A 3% increase in risk of CAD events was observed for patients with every 1% of the myocardium with resting defects (P < .0001). CONCLUSIONS: The estimation of CAD risk may be optimally estimated by use of a combination of resting MPS, reflecting a patient's burden of disease, and MPS with provocative ischemia.
Leslee J Shaw; Robert C Hendel; Gary V Heller; Salvador Borges-Neto; Manuel Cerqueira; Daniel S Berman
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-09-12
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  15     ISSN:  1532-6551     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    2008 Nov-Dec
Date Detail:
Created Date:  2008-11-05     Completed Date:  2009-04-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  762-73     Citation Subset:  IM    
Emory University School of Medicine, Atlanta, GA 30306, USA.
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MeSH Terms
Coronary Artery Disease / diagnosis*,  pathology
Exercise Test
Image Processing, Computer-Assisted
Ischemia / pathology*
Middle Aged
Myocardium / pathology*
Tomography, Emission-Computed, Single-Photon / methods*
Comment In:
J Nucl Cardiol. 2008 Nov-Dec;15(6):739-42   [PMID:  18984447 ]

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