title: Time to and risk of cardiac events after myocardial perfusion scintigraphy.
abstract: BACKGROUND
  The burden of cardiovascular disease is increasing, yet it remains difficult to focus preventive strategies on populations at highest absolute and relative risks. We compared absolute and relative cardiovascular event counts, plus time to first event, among patients undergoing myocardial perfusion scintigraphy (MPS).
  
  
  RESULTS
  Our database was queried to identify subjects without myocardial necrosis or recent revascularization, focusing on cardiac death (CD) or myocardial infarction (MI). A total of 13,254 patients were included, 5436 (41%) without, and 7818 (59%) with ischemia. After 32±21 months, subjects without ischemia, compared to those with ischemia, had lower absolute (16 vs 75 events, 18% vs 82%, p<0.001) and relative (0.3% vs 1.3%, p<0.001) risk of CD. Similar findings were obtained for MI (52 vs 81 events, 39% vs 61%, p<0.001, with corresponding rates of 1.0% vs 1.4%, p<0.001, respectively). Medical therapy appeared associated with fewer outcomes in those without ischemia, with the opposite occurring for subjects with ischemia (p<0.001). Median times to event ranged between 13 and 25 months in patients without ischemia vs 2 and 14 months in those with ischemia (p<0.001 for all comparisons). Multivariable-adjusted and propensity matched analyses confirmed the independent prognostic role of myocardial ischemia and, apparently, revascularization.
  
  
  CONCLUSIONS
  Most fatal and non-fatal cardiac events appear to occur in patients with evidence of myocardial ischemia at MPS, especially those with moderate or severe ischemia not receiving revascularization during follow-up.
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy; ETISAN, Rome, Italy. Electronic address: francesco.nudi@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nudi
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy.
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Neri
authors.affiliation: Department of Nuclear Medicine, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Orazio
authors.initials: O
authors.lastname: Schillaci
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy; CMO, Torre Annunziata, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Pinto
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy; Ostia Radiologica, Ostia, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Procaccini
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vetere
authors.affiliation: Division of Cardiology, European Hospital, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tomai
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Coronary artery disease; Myocardial perfusion scintigraphy; Prognosis; Warranty period