Key result
Higher summed rest score is linked to ~15% higher mortality despite normal exercise ECG.
Why the study?
The long-term prognostic value of exercise myocardial perfusion imaging in patients with normal exercise electrocardiographic testing was not defined.
Does exercise myocardial perfusion imaging provide incremental prognostic value for mortality and MACE in patients with known or suspected coronary artery disease and normal exercise electrocardiographic testing?
Cohort (n=650)
Does exercise myocardial perfusion imaging provide incremental prognostic value for mortality and MACE in patients with known or suspected coronary artery disease and normal exercise electrocardiographic testing?
Exercise myocardial perfusion imaging provides significant incremental prognostic information for predicting 9-year mortality and MACE in patients with known or suspected CAD who have normal exercise ECGs.
Answers are grounded in this paper and cite their sources.
MPI may refine 9-year risk stratification beyond normal exercise ECG; leaves open whether routine addition improves outcomes or warrants prospective validation.
AIMS: 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. METHODS AND RESULTS: 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). CONCLUSION: 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.
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Schinkel et al. (2012) conducted a cohort in known or suspected coronary artery disease with normal exercise electrocardiographic testing (n=650). Myocardial perfusion imaging (MPI) variables (summed rest score) vs. Clinical and exercise electrocardiographic testing data alone was evaluated on mortality (HR 1.15, 95% CI 1.08-1.22, p=< 0.001). In patients with known or suspected coronary artery disease and normal exercise ECG, the summed rest score independently predicted mortality.
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