title: Risk stratification using line source attenuation correction with rest/stress Tc-99m sestamibi SPECT myocardial perfusion imaging.
abstract: BACKGROUND
  Although line source attenuation correction (AC) in SPECT MPI studies improves diagnostic accuracy, its prognostic value is less understood.
  
  
  METHODS
  Consecutive patients (n = 6,513) who underwent rest/stress AC ECG-gated SPECT MPI were followed for cardiac death or non-fatal myocardial infarction (MI). A 17-segment model and AC summed stress score (SSS) were used to classify images.
  
  
  RESULTS
  Of the 6,513 patients, cardiac death or non-fatal MI occurred in 267 (4.1%), over 2.0 ± 1.4 years. The AC-SSS in patients with a cardiac event (5.6 ± 7.8) was significantly higher than in those without (1.9 ± 4.6, P < .001). The annualized cardiac event rate in patients with an AC-SSS 1-3 (3.6%) was significantly higher than in those with an AC-SSS = 0 (1.1%, P < .001) but similar to that in those with an AC-SSS 4-8 (2.9%, P = .4). Accordingly, patients were classified to AC-SSS = 0, 1-8, and >8 with annualized cardiac event rates of 1.1%, 3.2%, and 8.5%, respectively (P < .0001). In multivariate analysis, an AC-SSS 1-8 and >8 emerged as independent predictors of cardiac events (P < .02 and P < .0001, respectively).
  
  
  CONCLUSIONS
  Rest/stress ECG-gated SPECT MPI with line source AC provides highly effective and incremental risk stratification for future cardiac events.
authors.affiliation: Division of Cardiology, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06034, USA, aa.ardestani@gmail.com.
authors.forename: Afrooz
authors.initials: A
authors.lastname: Ardestani
authors.forename: Alan W
authors.initials: AW
authors.lastname: Ahlberg
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Katten
authors.forename: Krista
authors.initials: K
authors.lastname: Santilli
authors.forename: Donna M
authors.initials: DM
authors.lastname: Polk
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Bateman
authors.forename: Gary V
authors.initials: GV
authors.lastname: Heller
mesh_terms: D000368:Aged; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D018570:Risk Assessment; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D017256:Technetium Tc 99m Sestamibi