Incremental prognostic value of stress/rest gated perfusion SPECT in patients with coronary artery disease--subanalysis of the J-ACCESS study.
BACKGROUND
This study aimed to reveal the incremental prognostic implications of perfusion/function variables by stress/rest gated single-photon emission computed tomography (SPECT) over clinical risks in patients with known coronary artery disease (CAD).


RESULTS
Using the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS) database, the 3-year follow-up data of 2,200 patients who had established CAD were analyzed. Major cardiac events (cardiac death, myocardial infarction, heart failure, and unstable angina) were observed in 167 (7.6%) patients. Multivariate logistic regression analysis identified peripheral artery disease, diabetes mellitus, no use of statins, typical chest pain, pharmacological stress test, heart rate at rest, left ventricular end-systolic volume index derived from gated SPECT (LVESVI), and summed difference score (SDS) as independent significant predictors of the major cardiac events, with odds ratios of 1.025 to 2.291 (P=0.0309-0.0008). Global chi-square values increased by combining the independent predictors, and the greatest values (nearly 110) were observed when LVESVI or SDS was added to the pre-scan clinical information.


CONCLUSIONS
Perfusion/function measures by stress/rest gated SPECT contribute to a significant improvement in risk stratification and secondary prevention strategy in combination with pre-scan clinical risks in patients with known CAD.
Second Department of Internal Medicine (Cardiology), Sapporo Medical University School of Medicine, Sapporo, Japan. ahashimo@sapmed.ac.jp
Akiyoshi
A
Hashimoto
Tomoaki
T
Nakata
Takeru
T
Wakabayashi
Hideo
H
Kusuoka
Tsunehiko
T
Nishimura
D000368:Aged; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000209:etiology; D044466:Asian People; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D002317:Cardiovascular Agents; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000208:ethnology / Q000209:etiology* / Q000401:mortality; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000401:mortality; D019992:Databases as Topic; D018450:Disease Progression; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
D002317:Cardiovascular Agents