title: Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies.
abstract: BACKGROUND
  Normal exercise single-photon emission computed tomography (SPECT) studies are associated with a low event rate (<1.0%/year) during short-term follow-up. The influence of cardiac risk factors on long-term outcomes in such patients has not been well studied.
  
  
  METHODS
  2,597 patients (55 ± 12 years, male 41%) without a history of heart disease and a normal exercise SPECT between the years 1995 and 2006 were followed for a mean 6.8 ± 3.1 years for all-cause mortality assessed for using the Social Security Death Index. Baseline clinical risk factors and other clinical information were recorded for each patient and compared to outcomes.
  
  
  RESULTS
  The mortality rate was 0.9%/year for our overall study population but varied according to individual baseline risk factors. Three coronary artery disease (CAD) risk factors were significant predictors of all-cause mortality: hypertension, diabetes, and smoking. When all three were absent, long-term all-cause mortality rate averaged 0.2%/year and when all three were present, all-cause mortality averaged 1.8%/year, constituting a 5.7-fold adjusted increase in risk (95% CI 2.7-12.8, P < .0001).
  
  
  CONCLUSIONS
  During follow-up, annualized mortality rate varies markedly according to the number of CAD risk factors in patients without known heart disease and a normal exercise SPECT stress. Despite overall excellent long-term prognosis of a normal exercise SPECT, the burden of traditional CAD risk factors exert a strong synergistic influence on long-term survival and warrant aggressive treatment in this patient population.
authors.affiliation: Division of Cardiology, Department of Medicine, St. Luke's-Roosevelt Hospital, 1111 Amsterdam Avenue, 3rd Floor Cardiology, New York, NY 10025, USA.
authors.forename: Azhar
authors.initials: A
authors.lastname: Supariwala
authors.forename: Seth
authors.initials: S
authors.lastname: Uretsky
authors.forename: Padmakshi
authors.initials: P
authors.lastname: Singh
authors.forename: Salim
authors.initials: S
authors.lastname: Memon
authors.forename: Surinder S
authors.initials: SS
authors.lastname: Khokhar
authors.forename: Omar
authors.initials: O
authors.lastname: Wever-Pinzon
authors.forename: Prashanth
authors.initials: P
authors.lastname: Atluri
authors.forename: Joseph
authors.initials: J
authors.lastname: Hersh
authors.forename: Hari K
authors.initials: HK
authors.lastname: Koppuravuri
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000209:etiology* / Q000401:mortality; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon