title: Prediction of 9-year cardiovascular outcomes by myocardial perfusion imaging in patients with normal exercise electrocardiographic testing.
abstract: OBJECTIVE
  Exercise myocardial perfusion imaging (MPI) is widely used, but the long-term prognostic value of this test in patients with normal exercise electrocardiographic testing is not defined.
  
  
  RESULTS
  A consecutive group of 650 patients (428 men, mean age: 56 ± 11 years) with known or suspected coronary artery disease underwent exercise electrocardiographic testing and MPI. Follow-up endpoints were mortality and major adverse cardiac events (MACE). Predictors of outcome were identified by multivariate logistic regression analysis using clinical, exercise electrocardiographic testing and single-photon emission computed tomography (SPECT) variables. A total of 324 (50%) patients had an abnormal SPECT, and 131 (20%) had completely or partially reversible perfusion defects. During a mean follow-up of 9.2 ± 2.0 years, 107 (23%) patients died, 69 (11%) had a non-fatal myocardial infarction, 90 (14%) underwent coronary artery bypass surgery, and 142 (22%) percutaneous coronary intervention. Multivariate analysis demonstrated that the summed rest score was an independent predictor of mortality [hazard ratio (HR): 1.15, 95% confidence interval (CI): (1.08-1.22], P < 0.001). The summed stress score was an independent predictor of MACE [HR: 1.09, 95% CI: (1.04-1.13), P < 0.001]. The addition of SPECT variables to clinical and exercise electrocardiographic testing data provided incremental prognostic information for the prediction of mortality and MACE (both P < 0.001).
  
  
  CONCLUSIONS
  Approximately 20% of patients with known or suspected coronary artery disease and normal exercise electrocardiographic testing have completely or partially reversible myocardial perfusion defects. MPI provides additional information for the prediction of 9-year cardiovascular outcomes in these patients.
authors.affiliation: Department of Cardiology, Erasmus MC, Thoraxcenter, Room Ba304, 's-Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands. a.schinkel@erasmusmc.nl
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Boiten
authors.forename: Jors N
authors.initials: JN
authors.lastname: van der Sijde
authors.forename: Pauline R
authors.initials: PR
authors.lastname: Ruitinga
authors.forename: Eric J G
authors.initials: EJ
authors.lastname: Sijbrands
authors.forename: Roelf
authors.initials: R
authors.lastname: Valkema
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
mesh_terms: D000368:Aged; D002319:Cardiovascular System; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000473:pathology; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome