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Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies.
MedLine Citation:
PMID:  21184207     Owner:  NLM     Status:  Publisher    
BACKGROUND: Normal exercise single-photon emission computed tomography (SPECT) studies are associated with a low event rate (<1.0%/year) during short-term follow-up. The influence of cardiac risk factors on long-term outcomes in such patients has not been well studied. MATERIAL AND METHODS: 2,597 patients (55 ± 12 years, male 41%) without a history of heart disease and a normal exercise SPECT between the years 1995 and 2006 were followed for a mean 6.8 ± 3.1 years for all-cause mortality assessed for using the Social Security Death Index. Baseline clinical risk factors and other clinical information were recorded for each patient and compared to outcomes. RESULTS: The mortality rate was 0.9%/year for our overall study population but varied according to individual baseline risk factors. Three coronary artery disease (CAD) risk factors were significant predictors of all-cause mortality: hypertension, diabetes, and smoking. When all three were absent, long-term all-cause mortality rate averaged 0.2%/year and when all three were present, all-cause mortality averaged 1.8%/year, constituting a 5.7-fold adjusted increase in risk (95% CI 2.7-12.8, P < .0001). CONCLUSIONS: During follow-up, annualized mortality rate varies markedly according to the number of CAD risk factors in patients without known heart disease and a normal exercise SPECT stress. Despite overall excellent long-term prognosis of a normal exercise SPECT, the burden of traditional CAD risk factors exert a strong synergistic influence on long-term survival and warrant aggressive treatment in this patient population.
Azhar Supariwala; Seth Uretsky; Padmakshi Singh; Salim Memon; Surinder S Khokhar; Omar Wever-Pinzon; Prashanth Atluri; Joseph Hersh; Hari K Koppuravuri; Alan Rozanski
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-12-24
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  -     ISSN:  1532-6551     ISO Abbreviation:  -     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Division of Cardiology, Department of Medicine, St. Luke's-Roosevelt Hospital, 1111 Amsterdam Avenue, 3rd Floor Cardiology, New York, NY, 10025, USA.
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