The additional prognostic value of myocardial perfusion SPECT in patients with known coronary artery disease with high exercise capacity
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The prognostic value of myocardial perfusion imaging (MPI) in patients with known coronary artery disease (CAD) and high exercise capacity is still unknown. We sought to determine the MPI additional prognostic value over electrocardiography (ECG) stress testing alone in patients with known CAD who achieved ≥ 10 metabolic equivalents (METs).
Methods and Results
We evaluated 926 patients with known CAD referred for MPI with exercise stress. Patients were followed for a mean of 32.4 ± 9.7 months for the occurrence of all-cause death or nonfatal myocardial infarction (MI). Those achieving ≥ 10 METs were younger, predominantly male, and had lower prevalence of cardiovascular risk factors. Patients reaching ≥ 10 METs had a lower annualized rate of hard events compared to their counterparts achieving < 10 METs (1.13%/year vs 3.95%/year, P < .001). Patients who achieved ≥ 10 METs with abnormal scans had a higher rate of hard events compared to those with normal scans (3.37%/year vs 0.57%/year, P = .023). Cardiac workload < 10 METs and an abnormal MPI scan were independent predictors of hard events.
MPI is able to stratify patients with known CAD achieving ≥ 10 METs for the occurrence of all-cause death and nonfatal MI, with incremental prognostic value over ECG stress test alone.
KeywordsCAD MPI SPECT ECG stress METs prognostic outcomes exercise capacity
Myocardial perfusion imaging
Coronary artery disease
Single photon emission computed tomography
Coronary artery bypass graft
Percutaneous coronary intervention
Summed stress score
Summed difference score
Summed rest score
The authors Thais R. Peclat, Ana Carolina do A. H. de Souza, Victor F. Souza, Aline M. K. Nakamoto, Felipe M. Neves, Izabella C. R. Silva, and Ronaldo S. L. Lima have nothing to disclose.
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