title: Technetium 99m sestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting. The Nuclear Utility in the Community (NUC) Study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the prognostic value of community-based myocardial perfusion imaging (MPI) and to assess the incremental value of individual components of (99m)Tc-sestamibi single photon emission computed tomography (SPECT).
  
  
  BACKGROUND
  Although the most rapid growth of MPI has been in community outpatient laboratories, its prognostic value has not been validated in this setting.
  
  
  METHODS
  We prospectively followed 1,612 consecutive patients undergoing stress (99m)Tc-sestamibi SPECT in an outpatient community laboratory who experienced 71 hard events over 24 +/- 7 months (0.2% lost to follow-up).
  
  
  RESULTS
  Patients whose scans were normal incurred an annualized event rate of 0.4%, compared with 2.3% for those with abnormal scans (p < 0.0001). Subset analysis demonstrated comparable risk stratification for women and men, diabetics, patients with normal resting ECGs, and those referred for pharmacologic and exercise stress. After adjusting for pre-test variables, multivariable Cox regression analysis found the most potent independent components of MPI to be, in order of importance, transient ischemic dilation, extent of reversibility, post-stress ejection fraction, extent and severity of the stress perfusion defect, and the overall test result (normal or abnormal). Each 1% decrement of ejection fraction predicted a 3% increase in risk (p = 0.0009). Post-MPI angiography and revascularization increased commensurate with the extent and severity of MPI result.
  
  
  CONCLUSIONS
  The prognostic value of perfusion imaging is portable and transferable to the outpatient community setting, with multiple components of MPI providing incremental prognostic information.
authors.affiliation: Mission Internal Medical Group, Mission Viejo, California 92691, USA. gthomas@mimg.com
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Thomas
authors.forename: Michael I
authors.initials: MI
authors.lastname: Miyamoto
authors.forename: A Peter
authors.initials: AP
authors.lastname: Morello
authors.forename: Haresh
authors.initials: H
authors.lastname: Majmundar
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Thomas
authors.forename: Christine H
authors.initials: CH
authors.lastname: Sampson
authors.forename: Rory
authors.initials: R
authors.lastname: Hachamovitch
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005080:Exercise Test; D005260:Female; D006334:Heart Function Tests / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012111:Residence Characteristics; D016019:Survival Analysis; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D017256:Technetium Tc 99m Sestamibi