title: Incremental prognostic power of single-photon emission computed tomographic myocardial perfusion imaging in patients with known or suspected coronary artery disease.
abstract: Noninvasive stress testing provides prognostic information in patients who have suspected coronary artery disease, but limited data are available on the incremental value of myocardial perfusion testing in high-risk patients. We studied 3,275 patients who underwent cardiac catheterization and single-photon emission computed tomographic (SPECT) perfusion imaging. Median follow-up was 3.1 years for death, cardiovascular death, and a composite of cardiovascular death or nonfatal myocardial infarction. Using Cox's proportional hazards regression models, we examined the relation of SPECT summed stress score (SSS) to each outcome. A 1-unit change in SSS was associated with increased risks of 4%, 7%, and 5% for death, cardiovascular death, and death or nonfatal myocardial infarction, respectively (all p <0.0001). To examine the prognostic utility of SPECT, after baseline adjustments, SSS and angiographic results provided incremental prognostic information for each outcome. Thus, SPECT SSS provides information beyond clinical and angiographic data in patients who have known or suspected coronary artery disease. This information may be useful for stratifying patients into multiple risk categories for future cardiovascular events and potentially guiding therapy.
authors.affiliation: Department of Medicine (Cardiology), Duke University Medical Center, Durham, NC 27710, USA. borge001@mc.duke.edu
authors.forename: Salvador
authors.initials: S
authors.lastname: Borges-Neto
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.forename: Robert H
authors.initials: RH
authors.lastname: Tuttle
authors.forename: John H
authors.initials: JH
authors.lastname: Alexander
authors.forename: William T
authors.initials: WT
authors.lastname: Smith
authors.forename: Marianna
authors.initials: M
authors.lastname: Chambless
authors.forename: R Edward
authors.initials: RE
authors.lastname: Coleman
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*