title: Comparison of the prognostic value of regadenoson and adenosine myocardial perfusion imaging.
abstract: BACKGROUND
  Regadenoson is now widely used in single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). However, the prognostic value of abnormal stress perfusion findings with regadenoson vs adenosine are unclear. The aim of this study was to evaluate the prognostic value of regadenoson SPECT and to compare it to that of adenosine SPECT.
  
  
  RESULTS
  3698 consecutive patients undergoing either adenosine or regadenoson SPECT were assessed at 1 year for the endpoints of cardiovascular death and a composite endpoint of cardiovascular death or MI. Weighted Cox proportional hazards regression modeling with the inverse probability weighted (IPW) estimators method adjusting to propensity for agent was used to account for differences in baseline characteristics. Patients undergoing adenosine SPECT MPI had a significantly higher prevalence of smoking history, diabetes, hypertension, and prior myocardial infarction (P < .05, all). At 1 year of follow-up, there were 154 cardiovascular deaths and 204 with the composite endpoint of cardiovascular death or MI. Using IPW adjustment to propensity for agent in a model with stress agent, summed stress score (SSS) remained a significant predictor of the composite endpoint of cardiovascular death or MI (HR 1.36 CI 1.28-1.46; P < .0001) as well as cardiovascular death (HR 1.38 CI 1.28-1.49; P < .0001). The interaction of SSS with agent was not significant. Similar findings were seen with summed difference score (SDS).
  
  
  CONCLUSIONS
  SSS derived from either adenosine or regadenoson SPECT MPI is a significant predictor of events and provides incremental prognostic information beyond basic clinical variables. We have shown for the first time that use of regadenoson vs adenosine as stress agent does not modify the prognostic significance of SSS. Similar findings were seen with SDS.
authors.affiliation: Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA, afshin@uic.edu.
authors.forename: Afshin
authors.initials: A
authors.lastname: Farzaneh-Far
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.forename: Allison
authors.initials: A
authors.lastname: Dunning
authors.forename: Jorge D
authors.initials: JD
authors.lastname: Oldan
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Salvador
authors.initials: S
authors.lastname: Borges-Neto
mesh_terms: D000241:Adenosine; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D011687:Purines; D011720:Pyrazoles; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014665:Vasodilator Agents
chemical_list: D011687:Purines; D011720:Pyrazoles; D014665:Vasodilator Agents; C430916:regadenoson; D000241:Adenosine