Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 61, Issue 2, Pages 176-184Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2012.09.043
Keywords
myocardial perfusion imaging; positron emission tomography; prognosis; registry; risk reclassification
Categories
Funding
- Astellas Pharma Global Development
- Bracco Diagnostics, Inc
- National Heart, Lung, and Blood Institute [K23HL092299]
- Heart and Stroke Foundation of Ontario [PRG6242]
- Astellas Pharma
- Bracco Diagnostics
- Toshiba
- Lantheus Medical Imaging
- GE Healthcare
- MDS Nordion
- Siemens
- Cardium Therapeutics, Inc.
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Objectives The primary objective of this multicenter registry was to study the prognostic value of positron emission tomography (PET) myocardial perfusion imaging (MPI) and the improved classification of risk in a large cohort of patients with suspected or known coronary artery disease (CAD). Background Limited prognostic data are available for MPI with PET. Methods A total of 7,061 patients from 4 centers underwent a clinically indicated rest/stress rubidium-82 PET MPI, with a median follow-up of 2.2 years. The primary outcome of this study was cardiac death (n = 169), and the secondary outcome was all-cause death (n = 570). Net reclassification improvement (NRI) and integrated discrimination analyses were performed. Results Risk-adjusted hazard of cardiac death increased with each 10% myocardium abnormal with mildly, moderately, or severely abnormal stress PET (hazard ratio [HR]: 2.3 [95% CI: 1.4 to 3.8; p = 0.001], HR: 4.2 [95% CI: 2.3 to 7.5; p < 0.001], and HR: 4.9 [95% CI: 2.5 to 9.6; p < 0.0001], respectively [normal MPI: referent]). Addition of percent myocardium ischemic and percent myocardium scarred to clinical information (age, female sex, body mass index, history of hypertension, diabetes, dyslipidemia, smoking, angina, beta-blocker use, prior revascularization, and resting heart rate) improved the model performance (C-statistic 0.805 [95% CI: 0.772 to 0.838] to 0.839 [95% CI: 0.809 to 0.869]) and risk reclassification for cardiac death (NRI 0.116 [95% CI: 0.021 to 0.210]), with smaller improvements in risk assessment for all-cause death. Conclusions In patients with known or suspected CAD, the extent and severity of ischemia and scar on PET MPI provided powerful and incremental risk estimates of cardiac death and all-cause death compared with traditional coronary risk factors. (J Am Coll Cardiol 2013; 61: 176-84) (C) 2013 by the American College of Cardiology Foundation
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