title: Predictors of high-risk coronary artery disease in subjects with normal SPECT myocardial perfusion imaging.
abstract: While uncommon, normal stress SPECT myocardial perfusion imaging (MPI) can be seen in patients with high-risk coronary artery disease (CAD) by invasive coronary angiography (ICA).The predictors of high-risk CAD in patients with normal SPECT-MPI have not been described.
  
  
  
  We studied 580 patients (age 64 ± 12 years, 49% men) without known CAD who underwent stress-gated SPECT-MPI [exercise (41%) or vasodilator (59%)] <2 months before ICA and had summed stress score (SSS) <4. High-risk CAD was defined as 3 vessels with ≥70% stenosis, 2 vessels with ≥70% stenosis including proximal left anterior descending, or left main with ≥50% stenosis. Obstructive non-high-risk CAD was defined by the presence of a ≥70% stenosis but without having other high-risk criteria. Tenfold cross-validated receiver operating characteristic (ROC) estimates were obtained to assess the predictors of high-risk CAD.
  
  
  
  Forty-two subjects (7.2%) had high-risk CAD and 168 (29.0%) had obstructive non-high-risk CAD. Variables associated with high-risk CAD were pretest probability of CAD ≥66% (Odds ratio [OR] 3.63, 95% CI 1.6-8.3, P = .002), SSS > 0 (OR 7.46, 95% CI 2.6-21.1, P < 0.001), and abnormal TID (OR 2.16, 95% CI 1.0-4.5, P = 0.044). When substituted for TID, EF change was also predictive of high-risk CAD (OR 0.93, 95% CI 0.9-1.0, P = 0.023). The prevalence of high-risk CAD increased as the number of these predictors increased. In a sub-analysis of patients in whom quantitative total perfusion deficit (TPD) was available, TPD > 0 was also a predictor of high-risk CAD (OR 6.01, 95% CI 1.5-22.2, P = 0.011).
  
  
  
  Several clinical, stress, and SPECT-MPI findings are associated high-risk CAD among patients with normal SPECT-MPI. Consideration of these factors may improve the overall assessment of the likelihood of high-risk CAD in patients undergoing stress SPECT-MPI.
authors.affiliation: Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Rine
authors.initials: R
authors.lastname: Nakanishi
authors.affiliation: Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Gransar
authors.affiliation: Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Piotr
authors.initials: P
authors.lastname: Slomka
authors.affiliation: Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Arsanjani
authors.affiliation: Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Aryeh
authors.initials: A
authors.lastname: Shalev
authors.affiliation: Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Otaki
authors.affiliation: Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Friedman
authors.affiliation: Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Sean W
authors.initials: SW
authors.lastname: Hayes
authors.affiliation: Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Louise E B
authors.initials: LE
authors.lastname: Thomson
authors.affiliation: Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA.
authors.forename: Mathews
authors.initials: M
authors.lastname: Fish
authors.affiliation: Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Guido
authors.initials: G
authors.lastname: Germano
authors.affiliation: Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA.
authors.forename: Aiden
authors.initials: A
authors.lastname: Abidov
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Leslee
authors.initials: L
authors.lastname: Shaw
authors.affiliation: Division of Cardiology, St. Luke's Roosevelt Hospital, New York, NY, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
authors.affiliation: Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA. bermand@cshs.org.|Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. bermand@cshs.org.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005189:False Positive Reactions; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods / Q000706:statistics & numerical data*; D009922:Oregon / Q000453:epidemiology; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods / Q000706:statistics & numerical data*
keywords: High risk of coronary artery disease; SPECT-MPI; Single-photon emission computed tomography myocardial perfusion imaging