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Journal of Nuclear Cardiology

, Volume 21, Issue 2, pp 341–350 | Cite as

Long-term mortality following normal exercise myocardial perfusion SPECT according to coronary disease risk factors

  • Alan RozanskiEmail author
  • Heidi Gransar
  • James K. Min
  • Sean W. Hayes
  • John D. Friedman
  • Louise E. J. Thomson
  • Daniel S. Berman
Original Article

Abstract

Background

While normal exercise myocardial perfusion imaging (SPECT-MPI) is a robust predictor of low short-term clinical risk, there is increasing interest in ascertaining how clinical factors influence long-term risk following SPECT-MPI.

Methods

We evaluated the predictors of outcome from clinical data obtained at the time of testing in 12,232 patients with normal exercise SPECT-MPI studies. All-cause mortality (ACM) was assessed at a mean of 11.2 ± 4.5 years using the Social Security Death Index.

Results

The ACM rate was 0.8%/year, but varied markedly according to the presence of CAD risk factors. Hypertension, smoking, diabetes, exercise capacity, dyspnea, obesity, higher resting heart rate, an abnormal ECG, LVH, atrial fibrillation, and LVEF < 45% were all predictors of increased mortality. Risk factors were synergistic in predicting mortality: annualized age and gender-adjusted ACM rates ranged from only 0.2%/year among patients exercising for >9 minutes having none of three significant risk factors (among hypertension, diabetes, and smoking) to 1.6%/year among patients exercising <6 minutes and having ≥2 of these three risk factors. The age and gender-adjusted hazard ratio for mortality was increased by 7.3 (95% confidence interval 5.5-9.7) in the latter patients compared to those patients who exercised >9 minutes and had no significant risk factors (P < .001).

Conclusions

Long-term mortality risk varies markedly in accordance with baseline CAD risk factors and functional capacity among patients with normal exercise SPECT-MPI studies. Further study is indicated to determine whether the prospective characterization of both short-term and long-term risks following the performance of stress SPECT-MPI leads to improved clinical management.

Keywords

Prognosis tomography perfusion CAD risk factors 

Notes

Disclosures

None.

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Copyright information

© American Society of Nuclear Cardiology 2013

Authors and Affiliations

  • Alan Rozanski
    • 1
    • 2
    • 3
    Email author
  • Heidi Gransar
    • 1
    • 2
    • 3
  • James K. Min
    • 1
    • 2
    • 3
  • Sean W. Hayes
    • 1
    • 2
    • 3
  • John D. Friedman
    • 1
    • 2
    • 3
  • Louise E. J. Thomson
    • 1
    • 2
    • 3
  • Daniel S. Berman
    • 1
    • 2
    • 3
  1. 1.Division of CardiologySt. Lukes Roosevelt HospitalNew YorkUSA
  2. 2.Departments of Imaging and Medicine and Burns and Allen Research InstituteCedars-Sinai Medical CenterLos AngelesUSA
  3. 3.Department of Medicine, David Geffen School of MedicineUCLALos AngelesUSA

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