Incremental prognostic value of cardiac function assessed by ECG-gated myocardial perfusion SPECT for the prediction of future acute coronary syndrome

Circ J. 2008 Dec;72(12):2035-9. doi: 10.1253/circj.cj-08-0488. Epub 2008 Oct 24.

Abstract

Background: The prognostic value of ECG-gated rest 201Tl/stress 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography for the prediction of acute coronary syndrome (ACS: myocardial infarction (MI) and unstable angina (UA)) and the implications of ejection fraction (EF) has not yet been defined in Japanese.

Methods and results: The 1,895 patients were followed up for the occurrence ACS. The mean follow-up interval was 26.9+/-15.5 months. The 142 patients with revascularization within 60 days were censored. Summed stress score (SSS) and summed difference score (SDS) were calculated. The 19 MI and 29 UA occurred (1.1% and 1.6%, respectively). Univariate Cox analysis showed that hypertension (Wald 5.09, p<0.05), poststress EF (Wald 10.9, p<0.01), SSS (Wald 12.4, p<0.001) and SDS (Wald 18.7, p<0.001) were significant predictors of ACS. Multivariate Cox analysis showed that hypertension (Wald 4.27, p<0.05) and SDS (Wald 8.59, p<0.01) were independent predictors. When multiple clinical risk factors (number of coronary risk factors > or =2), significant ischemia (SDS > or =4) and low EF (EF <45%) were applied to multivariate Cox analysis, the combination of significant ischemia and low EF showed the highest predictive value (Wald 11.9; p<0.001) for future ACS.

Conclusion: Poststress EF added incremental prognostic value for the prediction of ACS.

MeSH terms

  • Acute Coronary Syndrome / diagnostic imaging
  • Acute Coronary Syndrome / etiology*
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / physiopathology
  • Adenosine Triphosphate
  • Aged
  • Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography*
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / physiopathology
  • Coronary Artery Disease / therapy
  • Coronary Circulation*
  • Exercise Test
  • Female
  • Humans
  • Hypertension / complications
  • Hypertension / physiopathology
  • Japan / epidemiology
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Ischemia / complications
  • Myocardial Ischemia / physiopathology
  • Myocardial Perfusion Imaging / methods*
  • Myocardial Revascularization*
  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Radiopharmaceuticals
  • Risk Assessment
  • Risk Factors
  • Stroke Volume*
  • Thallium Radioisotopes
  • Time Factors
  • Treatment Outcome

Substances

  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Radiopharmaceuticals
  • Thallium Radioisotopes
  • technetium tc-99m tetrofosmin
  • Adenosine Triphosphate