title: Long-term mortality following normal exercise myocardial perfusion SPECT according to coronary disease risk factors.
abstract: BACKGROUND
  While normal exercise myocardial perfusion imaging (SPECT-MPI) is a robust predictor of low short-term clinical risk, there is increasing interest in ascertaining how clinical factors influence long-term risk following SPECT-MPI.
  
  
  METHODS
  We evaluated the predictors of outcome from clinical data obtained at the time of testing in 12,232 patients with normal exercise SPECT-MPI studies. All-cause mortality (ACM) was assessed at a mean of 11.2 ± 4.5 years using the Social Security Death Index.
  
  
  RESULTS
  The ACM rate was 0.8%/year, but varied markedly according to the presence of CAD risk factors. Hypertension, smoking, diabetes, exercise capacity, dyspnea, obesity, higher resting heart rate, an abnormal ECG, LVH, atrial fibrillation, and LVEF < 45% were all predictors of increased mortality. Risk factors were synergistic in predicting mortality: annualized age and gender-adjusted ACM rates ranged from only 0.2%/year among patients exercising for >9 minutes having none of three significant risk factors (among hypertension, diabetes, and smoking) to 1.6%/year among patients exercising <6 minutes and having ≥ 2 of these three risk factors. The age and gender-adjusted hazard ratio for mortality was increased by 7.3 (95% confidence interval 5.5-9.7) in the latter patients compared to those patients who exercised >9 minutes and had no significant risk factors (P < .001).
  
  
  CONCLUSIONS
  Long-term mortality risk varies markedly in accordance with baseline CAD risk factors and functional capacity among patients with normal exercise SPECT-MPI studies. Further study is indicated to determine whether the prospective characterization of both short-term and long-term risks following the performance of stress SPECT-MPI leads to improved clinical management.
authors.affiliation: Division of Cardiology, St. Lukes Roosevelt Hospital, New York, NY, USA, ar77@columbia.edu.
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
authors.forename: Heidi
authors.initials: H
authors.lastname: Gransar
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.forename: Sean W
authors.initials: SW
authors.lastname: Hayes
authors.forename: John D
authors.initials: JD
authors.lastname: Friedman
authors.forename: Louise E J
authors.initials: LE
authors.lastname: Thomson
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012016:Reference Values; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*