Incremental prognostic value of stress/rest gated perfusion SPECT in patients with coronary artery disease--subanalysis of the J-ACCESS study

Circ J. 2009 Dec;73(12):2288-93. doi: 10.1253/circj.cj-09-0212. Epub 2009 Oct 2.

Abstract

Background: This study aimed to reveal the incremental prognostic implications of perfusion/function variables by stress/rest gated single-photon emission computed tomography (SPECT) over clinical risks in patients with known coronary artery disease (CAD).

Methods and results: Using the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS) database, the 3-year follow-up data of 2,200 patients who had established CAD were analyzed. Major cardiac events (cardiac death, myocardial infarction, heart failure, and unstable angina) were observed in 167 (7.6%) patients. Multivariate logistic regression analysis identified peripheral artery disease, diabetes mellitus, no use of statins, typical chest pain, pharmacological stress test, heart rate at rest, left ventricular end-systolic volume index derived from gated SPECT (LVESVI), and summed difference score (SDS) as independent significant predictors of the major cardiac events, with odds ratios of 1.025 to 2.291 (P=0.0309-0.0008). Global chi-square values increased by combining the independent predictors, and the greatest values (nearly 110) were observed when LVESVI or SDS was added to the pre-scan clinical information.

Conclusions: Perfusion/function measures by stress/rest gated SPECT contribute to a significant improvement in risk stratification and secondary prevention strategy in combination with pre-scan clinical risks in patients with known CAD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angina, Unstable / diagnostic imaging
  • Angina, Unstable / etiology
  • Asians
  • Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography*
  • Cardiovascular Agents*
  • Cardiovascular Diseases / diagnostic imaging
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / mortality
  • Chi-Square Distribution
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / ethnology
  • Coronary Artery Disease / mortality
  • Databases as Topic
  • Disease Progression
  • Exercise Test*
  • Female
  • Heart Failure / diagnostic imaging
  • Heart Failure / etiology
  • Humans
  • Japan / epidemiology
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / etiology
  • Myocardial Perfusion Imaging / methods*
  • Odds Ratio
  • Predictive Value of Tests
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Time Factors

Substances

  • Cardiovascular Agents