title: The prognostic value of regadenoson myocardial perfusion imaging.
abstract: BACKGROUND
  Regadenoson (REGA), a selective adenosine A2A receptor agonist, is the most widely used stress agent for SPECT myocardial perfusion imaging (MPI) in the United States. The diagnostic accuracy of REGA MPI is comparable to Adenosine MPI, but its prognostic value is not well defined.
  
  
  METHODS
  We categorized 1,400 patients (700 consecutive normal and 700 consecutive abnormal REGA-MPIs) into 4 groups based on the perfusion defect size using automated quantitative analysis: Group 1: normal perfusion; Group 2: <10% of left ventricle; Group 3: 10%-20%; Group 4: >20%. The primary outcome was a composite of cardiac death, myocardial infarction (MI), and late coronary revascularization (CR >90 days after MPI).
  
  
  RESULTS
  Of the 1,400 patients (42% male, 37% diabetes, 21% heart failure, 26% end-stage renal disease), the primary outcome occurred in 23% (17% cardiac death, 4% MI, 6% late CR) during 46 ± 18 months of follow-up and 8% had early CR (within 90 days of MPI). Early CR occurred in 0.4%, 9%, 17%, and 17% and the primary outcome in 10%, 27%, 31%, and 43% in Groups 1-4, respectively (P < .001 for both). In an adjusted Cox proportional model, the hazard ratio for the primary outcome was 2.68 (1.77-4.06), 3.32 (2.28-4.83), and 4.05 (2.78-5.91) for Groups 2-4 compared to Group 1.
  
  
  CONCLUSIONS
  REGA MPI provides powerful prognostic information that has important implications in patient management and can guide clinical practice.
authors: Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 314, 1900 University BLVD, Birmingham, AL, 35294, USA. fadihage@uab.edu.|Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA. fadihage@uab.edu.
authors: Fadi G
authors: FG
authors: Hage
authors: Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 314, 1900 University BLVD, Birmingham, AL, 35294, USA.
authors: Gopal
authors: G
authors: Ghimire
authors: School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Davis
authors: D
authors: Lester
authors: Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 314, 1900 University BLVD, Birmingham, AL, 35294, USA.
authors: Joshua
authors: J
authors: Mckay
authors: Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 314, 1900 University BLVD, Birmingham, AL, 35294, USA.
authors: Steven
authors: S
authors: Bleich
authors: Department of Medicine, Louisiana State University, Baton Rouge, LA, USA.
authors: Stephanie
authors: S
authors: El-Hajj
authors: Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 314, 1900 University BLVD, Birmingham, AL, 35294, USA.
authors: Ami E
authors: AE
authors: Iskandrian
mesh_terms: D058908:Adenosine A2 Receptor Agonists; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D011687:Purines; D011720:Pyrazoles; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
chemical_list: D058908:Adenosine A2 Receptor Agonists; D011687:Purines; D011720:Pyrazoles; C430916:regadenoson
keywords: Myocardial perfusion imaging; prognosis; quantitative analysis; regadenoson