Prognostic value of myocardial perfusion SPECT images in combination with the maximal heart rate at exercise testing in Japanese patients with suspected ischemic heart disease: a sub-analysis of J-ACCESS.
OBJECTIVE
We assessed whether a combination of summed stress scores (SSS) using exercise myocardial perfusion SPECT (Ex-SPECT) and maximal heart rate accurately predicts cardiac events through a sub-analysis of J-ACCESS (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT) which was conducted to evaluate the prognosis of Japanese patients with suspected ischemic heart disease.


METHODS
In J-ACCESS, 2,373 patients with suspected coronary artery disease not receiving beta-blocker treatment underwent Ex-SPECT. These patients were categorized into the following four groups: Group A [achieved target heart rate (THR) and SSS < 4: n = 631], B (did not achieve THR and SSS < 4: n = 612), C (achieved THR and SSS >or= 4: n = 570), and D (did not achieve THR and SSS >or= 4: n = 560). We evaluated the incidence rate of cardiac events including cardiac death, myocardial infarction, and heart failure requiring hospital admission during a 3-year period.


RESULTS
In Group A, B, C, and D, 9 of 631 (1.4%), 15 of 612 (2.4%), 23 of 570 (4.0%) and 30 of 560 (5.4%) patients experienced cardiac events, respectively. Although the hazard ratio of the SSS >or= 4 was 2.45 (p < 0.001) and that of the attained THR was 0.69 (p = 0.10) in the multiple Cox regression analysis, Kaplan-Meier curves showed that the cardiac events rate was lower in the order of A, B, C, and D (p < 0.001).


CONCLUSIONS
The combination of SSS using Ex-SPECT and the maximal heart rate is a useful predictor of cardiac events in patients with suspected coronary artery disease.
Ueshima
Kenji
K
EBM Research Center, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan. k_ueshima@pbh.med.kyoto-u.ac.jp
Yamashina
Akira
A
Usami
Satoru
S
Yasuno
Shinji
S
Nishiyama
Osamu
O
Yamazaki
Takuya
T
Nakao
Kazuwa
K
Nishimura
Tsunehiko
T
D000368:Aged; D003627:Data Interpretation, Statistical; D005080:Exercise Test; D005260:Female; D006339:Heart Rate; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology*; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D013312:Stress, Physiological; D015899:Tomography, Emission-Computed, Single-Photon