Key result
Abnormal CZT-SPECT myocardial perfusion is linked to ~117% higher risk of adverse cardiovascular events.
Why the study?
The prognostic value of stress myocardial perfusion imaging by cadmium zinc telluride single-photon emission computed tomography for predicting adverse cardiovascular events in patients with known or suspected coronary artery disease was not well defined.
Meta-Analysis (n=36,415)
Yes
Abnormal CZT-SPECT MPI identifies higher-risk CAD patients; supports prognostic use but leaves open questions on management impact.
BACKGROUND: Aim of this study was to define the prognostic value of stress myocardial perfusion imaging by cadmium zinc telluride (CZT) single-photon emission computed tomography (SPECT) for prediction of adverse cardiovascular events in patients with known or suspected coronary artery disease (CAD). METHODS AND RESULTS: Studies published until November 2022 were identified by database search. We included studies using stress myocardial perfusion imaging by CZT-SPECT to evaluate subjects with known or suspected CAD and providing primary data of adverse cardiovascular events. Total of 12 studies were finally included recruiting 36,415 patients. Pooled hazard ratio (HR) for the occurrence of adverse events was 2.17 (95% confidence interval, CI, 1.78-2.65) and heterogeneity was 66.1% (P = 0.001). Five studies reported data on adjusted HR for the occurrence of adverse events. Pooled HR was 1.69 (95% CI, 1.44-1.98) and heterogeneity was 44.9% (P = 0.123). Seven studies reported data on unadjusted HR for the occurrence of adverse events. Pooled HR was 2.72 (95% CI, 2.00-3.70). Nine studies reported data useful to calculate separately the incidence rate of adverse events in patients with abnormal and normal myocardial perfusion. Pooled incidence rate ratio was 2.38 (95% CI, 1.39-4.06) and heterogeneity was 84.6% (P < 0.001). The funnel plot showed no evidence of asymmetry (P = 0.517). At meta-regression analysis, we found an association between HR for adverse events and presence of angina symptoms and family history of CAD. CONCLUSIONS: Stress myocardial perfusion imaging by CZT-SPECT is a valuable noninvasive prognostic indicator for adverse cardiovascular events in patients with known or suspected CAD.
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Assante et al. (2023) conducted a meta-analysis in suspected or known coronary artery disease (n=36,415). Abnormal myocardial perfusion by CZT-SPECT vs. Normal myocardial perfusion by CZT-SPECT was evaluated on Occurrence of adverse cardiovascular events (HR 2.17, 95% CI 1.78-2.65). Abnormal stress myocardial perfusion imaging by CZT-SPECT was associated with a more than twofold increased risk of adverse cardiovascular events (HR 2.17) compared to normal perfusion.
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