Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 762-773 |
| Number of pages | 12 |
| Journal | Journal of Nuclear Cardiology |
| Volume | 15 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 1 2008 |
| Externally published | Yes |
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Keywords
- infarction
- ischemia
- Myocardial perfusion single photon emission computed tomography
- prognosis
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Radiology Nuclear Medicine and imaging
Cite this
Prognostic estimation of coronary artery disease risk with resting perfusion abnormalities and stress ischemia on myocardial perfusion SPECT. / Shaw, Leslee J.; Hendel, Robert; Heller, Gary V.; Borges-Neto, Salvador; Cerqueira, Manuel; Berman, Daniel S.
In: Journal of Nuclear Cardiology, Vol. 15, No. 6, 01.11.2008, p. 762-773.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Prognostic estimation of coronary artery disease risk with resting perfusion abnormalities and stress ischemia on myocardial perfusion SPECT
AU - Shaw, Leslee J.
AU - Hendel, Robert
AU - Heller, Gary V.
AU - Borges-Neto, Salvador
AU - Cerqueira, Manuel
AU - Berman, Daniel S.
PY - 2008/11/1
Y1 - 2008/11/1
N2 - 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.
AB - 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.
KW - infarction
KW - ischemia
KW - Myocardial perfusion single photon emission computed tomography
KW - prognosis
UR - http://www.scopus.com/inward/record.url?scp=54449098273&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=54449098273&partnerID=8YFLogxK
U2 - 10.1007/BF03007357
DO - 10.1007/BF03007357
M3 - Article
C2 - 18984451
AN - SCOPUS:54449098273
VL - 15
SP - 762
EP - 773
JO - Journal of Nuclear Cardiology
JF - Journal of Nuclear Cardiology
SN - 1071-3581
IS - 6
ER -