title: Correlation of chronic kidney disease, diabetes and peripheral artery disease with cardiovascular events in patients using stress myocardial perfusion imaging.
abstract: OBJECTIVE
  Normal stress myocardial perfusion imaging (MPI) studies generally suggest an excellent prognosis for cardiovascular events. Chronic kidney disease (CKD), diabetes and peripheral artery disease (PAD) have been established as the risk factors for cardiovascular events. However, whether these risk factors significantly predict cardiovascular events in patients with normal stress MPI is unclear. The purpose of this study was to evaluate the prognostic value of these risk factors in patients with normal stress MPI.
  
  
  METHODS
  Patients with normal stress MPI (n = 372, male = 215 and female = 157, age = 69 years, CKD without hemodialysis = 95, diabetes = 99, PAD = 19, previous coronary artery disease = 116) were followed up for 14 months. Normal stress MPI was defined as a summed stress score of <4 and a summed difference score of <2. CKD was defined by an estimated glomerular filtration rate of <60 ml/min/1.73 m(2) and/or persistent proteinuria. Cardiovascular events included cardiac death, non-fatal myocardial infarction and congestive heart failure requiring hospitalization.
  
  
  RESULTS
  Cardiovascular events occurred in 20 of 372 patients (5.4%). In univariate Cox regression analysis, PAD, diabetes, diabetic retinopathy, insulin use, anemia, hypoalbuminemia, CKD, left ventricular ejection fraction and pharmacological stress tests were significant predictors of cardiovascular events. In multivariate Cox regression analysis, PAD, diabetes and CKD were independent and significant predictors for cardiovascular events, and their number was the strongest predictor for cardiovascular events (hazard ratio = 21.7, P < 0.001).
  
  
  CONCLUSIONS
  PAD, diabetes and CKD are coexisting, independent and significant risk factors for cardiovascular events, CKD being the strongest predictor. The number of coexisting risk factors is important in predicting cardiovascular events in patients with normal stress MPI.
authors.affiliation: Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Furuhashi
authors.forename: Masao
authors.initials: M
authors.lastname: Moroi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Masai
authors.forename: Taeko
authors.initials: T
authors.lastname: Kunimasa
authors.forename: Ryo
authors.initials: R
authors.lastname: Nakazato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukuda
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugi
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002908:Chronic Disease; D048909:Diabetes Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D055414:Myocardial Perfusion Imaging; D058729:Peripheral Arterial Disease / Q000150:complications*; D011379:Prognosis; D012307:Risk Factors; D013312:Stress, Physiological