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Arend F.L. Schinkel, Henk J. Boiten, Jors N. van der Sijde, Pauline R. Ruitinga, Eric J.G. Sijbrands, Roelf Valkema, Ron T. van Domburg, Prediction of 9-year cardiovascular outcomes by myocardial perfusion imaging in patients with normal exercise electrocardiographic testing, European Heart Journal - Cardiovascular Imaging, Volume 13, Issue 11, November 2012, Pages 900–904, https://doi.org/10.1093/ehjci/jes104
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Abstract
Exercise myocardial perfusion imaging (MPI) is widely used, but the long-term prognostic value of this test in patients with normal exercise electrocardiographic testing is not defined.
A consecutive group of 650 patients (428 men, mean age: 56 ± 11 years) with known or suspected coronary artery disease underwent exercise electrocardiographic testing and MPI. Follow-up endpoints were mortality and major adverse cardiac events (MACE). Predictors of outcome were identified by multivariate logistic regression analysis using clinical, exercise electrocardiographic testing and single-photon emission computed tomography (SPECT) variables. A total of 324 (50%) patients had an abnormal SPECT, and 131 (20%) had completely or partially reversible perfusion defects. During a mean follow-up of 9.2 ± 2.0 years, 107 (23%) patients died, 69 (11%) had a non-fatal myocardial infarction, 90 (14%) underwent coronary artery bypass surgery, and 142 (22%) percutaneous coronary intervention. Multivariate analysis demonstrated that the summed rest score was an independent predictor of mortality [hazard ratio (HR): 1.15, 95% confidence interval (CI): (1.08–1.22], P < 0.001). The summed stress score was an independent predictor of MACE [HR: 1.09, 95% CI: (1.04–1.13), P < 0.001]. The addition of SPECT variables to clinical and exercise electrocardiographic testing data provided incremental prognostic information for the prediction of mortality and MACE (both P < 0.001).
Approximately 20% of patients with known or suspected coronary artery disease and normal exercise electrocardiographic testing have completely or partially reversible myocardial perfusion defects. MPI provides additional information for the prediction of 9-year cardiovascular outcomes in these patients.
- myocardial infarction
- electrocardiogram
- percutaneous coronary intervention
- coronary artery bypass surgery
- coronary arteriosclerosis
- myocardial perfusion
- single photon emission computed tomography
- cardiac event
- exercise
- cardiovascular system
- follow-up
- perfusion
- mortality
- patient prognosis
- stress
- surrogate endpoints
- myocardial perfusion imaging