title: Registry for the Evaluation of the PROgnostic value of a novel integrated imaging approach combining Single Photon Emission Computed Tomography with coronary calcification imaging (REPROSPECT).
abstract: OBJECTIVE
  Although an added diagnostic and prognostic value of the global coronary artery calcification (CAC) score as an adjunct to single-photon emission computed tomography (SPECT)-myocardial perfusion image (MPI) has been repeatedly documented, none of the previous studies took advantage of the anatomic information provided by the unenhanced cardiac CT. Therefore, no co-registration has so far been used to match a myocardial perfusion defect with calcifications in the subtending coronary artery. To evaluate the prognostic value of integrating SPECT-MPI with CAC images were obtained from non-enhanced cardiac computed tomography (CT) for attenuation correction to predict major adverse cardiac events (MACE).
  
  
  RESULTS
  Follow-up was obtained in 462 patients undergoing a 1-day stress/rest (99m)Tc-teterofosmin SPECT and non-enhanced cardiac CT for attenuation correction. Survival free of MACE was determined using the Kaplan-Meier method. After integrating MPI and CT findings, patients were divided into three groups (i) MPI defect matched by calcification (CAC ≥ 1) in the subtending coronary artery (ii) unmatched MPI and CT finding (iii) normal finding by MPI and CT. At a mean follow-up of 34.5 ± 13 months, a MACE was observed in 80 patients (33 death, 6 non-fatal myocardial infarction, 9 hospitalizations due to unstable angina, and 32 revascularizations). Survival analysis revealed the most unfavourable outcome (P < 0.001 log-rank test) for patients with a matched finding.
  
  
  CONCLUSIONS
  In the present study, a novel approach using a combined integration of cardiac SPECT-CAC imaging allows for refined risk stratification, as a matched defect emerged as an independent predictor of MACE.
authors.affiliation: Department of Radiology, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 32, Zurich CH-8091, Switzerland.
authors.forename: Jelena R
authors.initials: JR
authors.lastname: Ghadri
authors.forename: Michael
authors.initials: M
authors.lastname: Fiechter
authors.forename: Tobias A
authors.initials: TA
authors.lastname: Fuchs
authors.forename: Andreas
authors.initials: A
authors.lastname: Scherrer
authors.forename: Julia
authors.initials: J
authors.lastname: Stehli
authors.forename: Cathérine
authors.initials: C
authors.lastname: Gebhard
authors.forename: Bernd
authors.initials: B
authors.lastname: Kläser
authors.forename: Oliver
authors.initials: O
authors.lastname: Gaemperli
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Christian
authors.initials: C
authors.lastname: Templin
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods