title: Assessing the prognostic implications of myocardial perfusion studies: identification of patients at risk vs patients who may benefit from intervention?
abstract: Stress myocardial perfusion imaging (MPI) has a well-established role in improving risk stratification. Recent analyses, compared with older data, suggest that the yield of stress MPI has decreased. In part, this trend relates to testing patients with heterogeneous, but improved, risk factor modification. In this setting, positron emission tomography with myocardial flow reserve enhances risk stratification as it reflects the end result of atherosclerosis. Recent studies have also emphasized the clinical impact of incremental risk stratification by assessing net reclassification improvement (NRI). Previous retrospective studies have favored an ischemic threshold to select patients that benefit from revascularization, but this finding has not been corroborated in randomized trials. However, no large randomized trial has directly tested a strategy of revascularization for patients with at least a moderate amount of ischemia at risk. Unfortunately, even when faced with a significantly abnormal MPI result, subsequent action is too often absent.
authors.affiliation: Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Desk J1-5 9500 Euclid Avenue, Cleveland, OH, 44915, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Cremer
authors.forename: Rory
authors.initials: R
authors.lastname: Hachamovitch
mesh_terms: D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D055414:Myocardial Perfusion Imaging; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon