title: Prognostic impact of location and extent of vessel-related ischemia at myocardial perfusion scintigraphy in patients with or at risk for coronary artery disease.
abstract: BACKGROUND
  Myocardial perfusion scintigraphy (MPS) has an established diagnostic and prognostic role in patients with or at risk for coronary artery disease, with ischemia severity and extent having already been identified as key predictors. Whether this is affected by the location of myocardial ischemia is uncertain. We aimed at comparing the prognostic outlook of patients undergoing MPS according to the site of ischemia.
  
  
  METHODS
  Our institutional database was queried for subjects undergoing MPS, without myocardial necrosis or recent revascularization. We focused on the prognostic impact of location of vessel-related ischemia (VRI) at MPS, distinguishing four mutually exclusive groups: single-VRI involving left anterior descending (LAD), single-VRI not involving LAD, multi-VRI involving LAD, and multi-VRI not involving LAD. The primary outcome was the long-term (>1 year) rate of death or myocardial infarction (D/MI).
  
  
  RESULTS
  A total of 13,254 patients were included. Moderate or severe VRI occurred in 2,627 (20%) patients. Clinical outcomes were significantly different among the groups of patients with moderate or severe VRI, including death, cardiac death, non-fatal myocardial infarction or their composites (overall P < .001). Specifically, and excluding subjects undergoing revascularization as first follow-up event, D/MI occurred in 8.4% of patients with single-VRI involving LAD, 5.5% of subjects with single-VRI not involving LAD, 16.5% of those with multi-VRI involving LAD, and 7.3% of patients with multi-VRI not involving LAD (overall P < .001). Even at incremental multivariable Cox proportional analysis, hierarchical VRI was independently associated with an increased risk of D/MI [hazard ratio = 1.17 (1.04-1.08) for each class increment, P = .010].
  
  
  CONCLUSIONS
  Location and extent of myocardial ischemia at MPS according to the VRI concept have a hierarchical predictive impact, with multi-VRI involving LAD being significantly and independently more prognostically ominous than other types of VRI.
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy. francesco.nudi@gmail.com.|ETISAN, Rome, Italy. francesco.nudi@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nudi
authors.affiliation: Institute of Nuclear Medicine, Tor Vergata University, Rome, Italy.
authors.forename: Orazio
authors.initials: O
authors.lastname: Schillaci
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy.
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Neri
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy.|Ostia Radiologica, Rome, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Pinto
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy.|Ostia Radiologica, Rome, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Procaccini
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vetere
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: 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: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011379:Prognosis
keywords: Coronary artery disease; maximal ischemia score; myocardial perfusion scintigraphy; vessel-related ischemia
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