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Prediction of 2-year major adverse cardiac events from myocardial perfusion scintigraphy and clinical risk factors

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

We developed CRAX2MACE, a new tool derived from clinical and SPECT myocardial perfusion imaging (MPI) variables, to predict 2-year probability of major adverse cardiac event (MACE) comprising death, hospitalized acute myocardial infarction or coronary revascularization.

Methods

Consecutive individuals with SPECT MPI 2001-2008 had two-year MACE determined from population-based health services data. CRAX2MACE included age, sex, diabetes, recent cardiac hospitalization, pharmacologic stress, stress total perfusion deficit (TPD), ischemic (stress-rest) TPD, left ventricular ejection fraction and transient ischemic dilation ratio. Two-year event rates were classified as low (< 5%), moderate (5.0-9.9%), high (10-19.9%) and very high (20% or greater).

Results

The study population comprised 3896 individuals for the development and 1946 for the validation subgroups with subsequent MACE in 589 (15.1%) and 272 (14.0%), respectively. CRAX2MACE, derived from the development subgroups, accurately stratified MACE risk in the validation subgroup (area under the receiver operating characteristics curve 0.79) with stepwise increase in the observed event rate with increasing predicted risk category (low, 2.3%; moderate, 5.5%; high, 18.8%; very high 33.2%; P-trend < 0.001).

Conclusions

A simple tool based upon clinical risk factors and MPI variables predicts 2-year cardiac events. Risk stratification between the low and very high groups was greater than tenfold.

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Abbreviations

SPECT:

Single photon emission computed tomography

MPI:

Myocardial perfusion imaging

AMI:

Acute myocardial infarction

MACE:

Major adverse cardiac event

LVEF:

Left ventricular ejection fraction

TID:

Transient ischemic dilatation

TPD:

Total perfusion defect

CRAX:

Cardiovascular risk assessment

CRAX2MACE:

Cardiovascular risk assessment for MACE at 2 years

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Acknowledgements

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2012/2013-18). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Healthy Living, and Seniors, or other data providers are intended or should be inferred.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Manitoba, C5121-409 Tache Ave, Winnipeg, MB, R2H 2A6, Canada

    William D. Leslie MD MSc, Mark Bryanton MD & Andrew Goertzen PhD

  2. Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

    William D. Leslie MD MSc

  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Piotr Slomka PhD

Authors
  1. William D. Leslie MD MSc
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  2. Mark Bryanton MD
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  4. Piotr Slomka PhD
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Corresponding author

Correspondence to William D. Leslie MD MSc.

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Disclosure

W. Leslie, M. Bryanton and A. Goertzen declare that they have no conflict of interest. P. Slomka participates in software royalties at Cedars-Sinai Medical Center for the licensing of the software for myocardial perfusion quantification.

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All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Randall Thompson, MD.

Funding

This research was supported in part by the National Institutes of Health (NIH) Grant R01 HL089765 (P. Slomka).

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Appendix: Calculation of CRAX2MACE for estimating 2-year probability of MACE

Appendix: Calculation of CRAX2MACE for estimating 2-year probability of MACE

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Leslie, W.D., Bryanton, M., Goertzen, A. et al. Prediction of 2-year major adverse cardiac events from myocardial perfusion scintigraphy and clinical risk factors. J. Nucl. Cardiol. 29, 1956–1963 (2022). https://doi.org/10.1007/s12350-021-02617-7

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  • DOI: https://doi.org/10.1007/s12350-021-02617-7

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