title: 12-Year outcome after normal myocardial perfusion SPECT in patients with known coronary artery disease.
abstract: BACKGROUND
  Previous studies have reported a favorable outcome of patients with normal single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). The aim of this study was to assess the very long-term prognosis of patients with known coronary artery disease (CAD) and normal SPECT MPI results.
  
  
  METHODS
  The population consisted of 266 patients with known CAD (defined as a healed myocardial infarction and/or a previous coronary revascularization), who underwent exercise bicycle or dobutamine-atropine stress SPECT MPI and had normal perfusion during stress and at rest. End points during follow-up were all-cause mortality, cardiac mortality, and nonfatal myocardial infarction. Univariate and multivariate analyses were performed to identify predictors of long-term outcome.
  
  
  RESULTS
  Follow-up was completed in 261 (98%) patients. During a median follow-up of 12 years, 94 (36%) patients died, of which 26 (10%) died due to cardiac causes, and 15 (6%) had a nonfatal myocardial infarction. The annualized mortality rate was 3.1%, annualized cardiac mortality rate was 0.9%, and the annualized event rate for cardiac death and/or nonfatal infarction was 1.2%. Independent predictors of total mortality were age, diabetes mellitus, and rate-pressure product at peak stress. Independent predictors of cardiac mortality were age, male gender, and rate-pressure product at peak stress.
  
  
  CONCLUSIONS
  Patients with known CAD and a normal SPECT MPI study have a favorable long-term prognosis. Clinical and stress test variables can be used to identify patients with a higher risk status.
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Machiel J M
authors.initials: MJ
authors.lastname: Ottenhof
authors.forename: Marisa C G Tjong Joe
authors.initials: MC
authors.lastname: Wai
authors.forename: Hendrik J
authors.initials: HJ
authors.lastname: Boiten
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Korbee
authors.forename: Roelf
authors.initials: R
authors.lastname: Valkema
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
mesh_terms: D000368:Aged; D001285:Atropine / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D004280:Dobutamine / Q000627:therapeutic use; D005080:Exercise Test; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization; D011379:Prognosis; D012306:Risk; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D004280:Dobutamine; D001285:Atropine
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