title: Increased prognostic value of combined myocardial perfusion imaging and exercise electrocardiography in patients with coronary artery disease.
abstract: BACKGROUND
  Myocardial perfusion imaging (MPI) with technetium-99m-labeled sestamibi and exercise electrocardiography (EECG) are widely used for risk stratification of patients with known or suspected coronary artery disease (CAD). However, no large-scale studies have addressed the prognostic power of the combined information from these diagnostic tools.
  
  
  RESULTS
  We studied 697 consecutive patients who underwent a 2-day Tc-99m sestamibi cardiac perfusion imaging protocol. The EECG was performed on a bicycle ergometer by symptom-limited exercise. Causes of death were obtained from death certificates. Univariate survival analyses were performed with a Kaplan-Meier estimate and a corresponding log-rank test. A multivariate Cox proportional hazards model was applied to test for potential predictor covariates obtained from hospital records. The predominant risk factors of cardiac death were fixed perfusion defects (relative risk, 2.55; range, 1.43 to 4.55) and an impaired circulatory exercise response (relative risk, 3.26; range, 1.74 to 6.08). The major prognostic information of MPI was the ability to detect patients with a definitively low risk. Patients with impaired circulatory response to exercise test and fixed perfusion defects were at a very high risk.
  
  
  CONCLUSIONS
  The combined results of MPI and EECG provide substantial information on the long-term risk of cardiac death in patients with suspected CAD.
authors.affiliation: Department of Clinical Physiology, Herlev University Hospital, Copenhagen, Denmark. bozer@dadlnet.dk
authors.forename: B
authors.initials: B
authors.lastname: Zerahn
authors.forename: B V
authors.initials: BV
authors.lastname: Jensen
authors.forename: K D
authors.initials: KD
authors.lastname: Nielsen
authors.forename: S
authors.initials: S
authors.lastname: Møller
mesh_terms: D003326:Coronary Circulation; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi