title: Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry.
abstract: OBJECTIVE
  The primary objective of this multicenter registry was to study the prognostic value of positron emission tomography (PET) myocardial perfusion imaging (MPI) and the improved classification of risk in a large cohort of patients with suspected or known coronary artery disease (CAD).
  
  
  BACKGROUND
  Limited prognostic data are available for MPI with PET.
  
  
  METHODS
  A total of 7,061 patients from 4 centers underwent a clinically indicated rest/stress rubidium-82 PET MPI, with a median follow-up of 2.2 years. The primary outcome of this study was cardiac death (n = 169), and the secondary outcome was all-cause death (n = 570). Net reclassification improvement (NRI) and integrated discrimination analyses were performed.
  
  
  RESULTS
  Risk-adjusted hazard of cardiac death increased with each 10% myocardium abnormal with mildly, moderately, or severely abnormal stress PET (hazard ratio [HR]: 2.3 [95% CI: 1.4 to 3.8; p = 0.001], HR: 4.2 [95% CI: 2.3 to 7.5; p < 0.001], and HR: 4.9 [95% CI: 2.5 to 9.6; p < 0.0001], respectively [normal MPI: referent]). Addition of percent myocardium ischemic and percent myocardium scarred to clinical information (age, female sex, body mass index, history of hypertension, diabetes, dyslipidemia, smoking, angina, beta-blocker use, prior revascularization, and resting heart rate) improved the model performance (C-statistic 0.805 [95% CI: 0.772 to 0.838] to 0.839 [95% CI: 0.809 to 0.869]) and risk reclassification for cardiac death (NRI 0.116 [95% CI: 0.021 to 0.210]), with smaller improvements in risk assessment for all-cause death.
  
  
  CONCLUSIONS
  In patients with known or suspected CAD, the extent and severity of ischemia and scar on PET MPI provided powerful and incremental risk estimates of cardiac death and all-cause death compared with traditional coronary risk factors.
authors.affiliation: Brigham and Women's Hospital, Department of Radiology and Division of Cardiology, Noninvasive Cardiovascular Imaging Section, Boston, Massachusetts 02115, USA. sdorbala@partners.org
authors.forename: Sharmila
authors.initials: S
authors.lastname: Dorbala
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
authors.forename: Rob S
authors.initials: RS
authors.lastname: Beanlands
authors.forename: Michael E
authors.initials: ME
authors.lastname: Merhige
authors.forename: Brent A
authors.initials: BA
authors.lastname: Williams
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.forename: Benjamin J W
authors.initials: BJ
authors.lastname: Chow
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D003643:Death; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment / Q000145:classification; D012414:Rubidium Radioisotopes; D013318:Stroke Volume / Q000502:physiology
chemical_list: D012414:Rubidium Radioisotopes