Document Detail


Prognostic value of myocardial perfusion and ventricular function in a Japanese multicenter cohort study (J-ACCESS): the first-year total events and hard events.
MedLine Citation:
PMID:  19363705     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the prognostic value of myocardial ischemia, function and coronary risk factors on total and hard cardiac events using myocardial perfusion imaging in a Japanese population. METHODS: A prospective cohort study was performed in 117 Japanese hospitals, each with a nuclear cardiology facility. A total of 4,031 patients with suspected or confirmed ischemic heart disease were registered. The patients were followed up for a year to investigate total and hard events, and those who had any events were followed up for 3 years to evaluate subsequent hard events. A stress-rest gated myocardial perfusion study was performed with (99m)Tc-tetrofosmin using gated single-photon emission computed tomography (SPECT) and analyzed by semi-quantitative scores. RESULTS: During the 1-year follow-up period, 263 (6.5%) patients had total events comprising all-cause death, non-fatal myocardial infarction (MI), heart failure, unstable angina, angina pectoris and coronary revascularization. Cardiac death occurred in 23 patients (0.6%) and non-fatal MI in 11 (0.3%). Among patients with ejection fraction (EF) of <45% and a summed difference score (SDS) of >/=2, 18.7% (2.4% for cardiac death and 0.6% for non-fatal MI) experienced total events compared with 3.9% (0.3% for cardiac death and 0.2% for non-fatal MI; P < 0.0001) of those with EF >/= 45% and SDS < 2. Multivariate analysis identified EF, SDS, age, history of revascularization and diabetes as significant predictors of all events, while the significant predictors were age and EF for hard events. When the patients who had heart failure in the first year were followed up, 9 of 41 (22.0%) experienced cardiac death in the subsequent 3-year follow-up period. CONCLUSIONS: Myocardial ischemia defined by SDS and ventricular function were the main predictors of total events despite the relatively low incidence of hard events in this Japanese population. In patients with cardiac events in a year, closer attention should be paid to subsequent hard events particularly in patients with heart failure.
Authors:
Kenichi Nakajima; Hideo Kusuoka; Shigeyuki Nishimura; Akira Yamashina; Tsunehiko Nishimura
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2009-04-14
Journal Detail:
Title:  Annals of nuclear medicine     Volume:  23     ISSN:  0914-7187     ISO Abbreviation:  Ann Nucl Med     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-12     Completed Date:  2009-08-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8913398     Medline TA:  Ann Nucl Med     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  373-81     Citation Subset:  IM    
Affiliation:
Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan. nakajima@med.kanazawa-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina, Unstable / complications
Cohort Studies
Female
Follow-Up Studies
Heart Failure / complications
Humans
Japan
Male
Multivariate Analysis
Myocardial Ischemia / complications,  diagnosis*,  physiopathology*,  radionuclide imaging
Myocardial Perfusion Imaging*
Nuclear Medicine
Prognosis
Regression Analysis
Risk Factors
Time Factors
Tomography, Emission-Computed, Single-Photon
Ventricular Function*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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