From the Departments of Imaging (Division of Nuclear Medicine) and
Medicine (Division of Cardiology), Cedars-Sinai Medical Center, and the
Department of Medicine, UCLA School of Medicine, Los Angeles, Calif, and the
Division of Cardiology, Department of Medicine, Duke University Medical
Center, Durham, NC. Dr Hachamovitch is currently at the Division of
Cardiology, New York (NY) Hospital-Cornell Medical Center. Dr Shaw is
currently at the Department of Medicine (Division of Cardiology), Emory
University, Atlanta, Ga.
Correspondence to Daniel S. Berman, MD, Cedars-Sinai Medical Center, Room A042, 8700 Beverly Blvd, Los Angeles, CA 90048.
Background—The incremental
prognostic value of stress single photon emission computed tomography
(SPECT) for the prediction of cardiac death as an individual end point
and the implications for risk stratification are undefined.
Methods and Results—We identified 5183 consecutive patients
who underwent stress/rest SPECT and were followed up for the occurrence
of cardiac death or myocardial infarction. Over a mean follow up of
642±226 days, 119 cardiac deaths and 158 myocardial infarctions
occurred (3.0% cardiac death rate, 2.3% myocardial infarction rate).
Patients with normal scans were at low risk (
Conclusions—Myocardial perfusion SPECT yields incremental
prognostic information toward the identification of cardiac death.
Patients with mildly abnormal scans after exercise stress are at low
risk for cardiac death but intermediate risk for nonfatal myocardial
infarction and thus may benefit from a noninvasive strategy and may not
require invasive management.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Incremental Prognostic Value of Myocardial Perfusion Single Photon Emission Computed Tomography for the Prediction of Cardiac Death
Differential Stratification for Risk of Cardiac Death and Myocardial Infarction
0.5%/y), and rates of
both outcomes increased significantly with worsening scan
abnormalities. Patients who underwent exercise stress and had mildly
abnormal scans had low rates of cardiac death but higher rates of
myocardial infarction (0.7%/y versus 2.6%/y; P<.05).
After adjustment for prescan information, scan results provided
incremental prognostic value toward the prediction of cardiac death.
The identification of patients at intermediate risk of nonfatal
myocardial infarction and low risk for cardiac death by SPECT may
result in significant cost savings when applied to a clinical testing
strategy.
Key Words: prognosis • tomography • perfusion
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