title: Role of myocardial perfusion scintigraphy in predicting global cardiovascular risk and differentiating between patients with moderate and high cardiovascular risk.
abstract: OBJECTIVE
  The usefulness of stress myocardial perfusion scintigraphy (MPS) for cardiovascular (CV) risk stratification in patients at moderate and high CV risk remains controversial. We tested the hypothesis that different clinical risk profiles influence the test and the likelihood of obtaining a positive coronary angiography (CA) in the following 12 months.
  
  
  METHODS
  We assessed the prognostic value of MPS in 230 patients classified according to the European Society of Cardiology guidelines.
  
  
  RESULTS
  Patients at high and very-high CV risk had a higher prevalence of positive MPS (25.5 vs. 36.7%, P=0.014 and 9.8 vs. 19.5%, P=0.011, respectively), whereas patients at moderate risk had a higher prevalence of negative MPS (45.1 vs. 38.3, P=NS). Multivariate regression analysis showed that positive MPS was an independent predictor of 12-month positive CA only in patients at high CV risk [odds ratio (OR) 8.03, 95% confidence interval (CI) 1.53-42.03, P=0.014] independent of age>60 and coexistence of obesity and previous percutaneous coronary intervention (OR 3.78, 95% CI 1.18-12.78, P=0.032; OR 1.83, 95% CI 1.03-3.26, P=0.039). The C-statistic showed a good discriminatory power of positive MPS in predicting 12-month positive CA (0.68, 95% CI 0.55-0.80, P=0.015). Mantel-Cox analysis showed that after 12 months of follow-up, in patients at high risk, there was a statistically significant difference in the distribution of patients with positive than those without negative CA (log rank P=0.04).
  
  
  CONCLUSIONS
  CV risk stratification on the basis of MPS is useful only in patients at high and very-high CV risk. In these groups, MPS can aid stratification for the risk of CV events.
authors.affiliation: Departments of aCardiology bNuclear Medicine, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zuin
authors.forename: Lucia
authors.initials: L
authors.lastname: Rampin
authors.forename: Massimo
authors.initials: M
authors.lastname: Rinuncini
authors.forename: Claudio
authors.initials: C
authors.lastname: Picariello
authors.forename: Sotirios
authors.initials: S
authors.lastname: Chondrogiannis
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Loris
authors.initials: L
authors.lastname: Roncon
mesh_terms: D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity