Prognostic Value of Normal Exercise and Adenosine 99mTc-Tetrofosmin SPECT Imaging: Results from the Multicenter Registry of 4,728 Patients

Prognostic Value of Normal Exercise and Adenosine ^99mTc-Tetrofosmin SPECT Imaging: Results from the Multicenter Registry of 4,728 Patients

Leslee J. Shaw, PhD¹, Robert Hendel, MD², Salvador Borges-Neto, MD³, Michael S. Lauer, MD⁴, Naomi Alazraki, MD⁵, Joy Burnette, BS¹, Elizabeth Krawczynska, MD, PhD⁵, Manuel Cerqueira, MD⁶ and Jamshid Maddahi, MD⁷ for the Myoview Multicenter Registry

¹ Atlanta Cardiovascular Research Institute, Atlanta, Georgia
² Rush–Presbyterian–St. Luke’s Medical Center, Chicago, Illinois
³ Duke University Medical Center, Durham, North Carolina
⁴ The Cleveland Clinic Foundation, Cleveland, Ohio
⁵ Emory University, Atlanta, Georgia
⁶ Georgetown University Medical Center, Washington, DC
⁷ University of California Los Angeles School of Medicine, Los Angeles, California

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FIGURE 1. Risk-adjusted (controlling for age, sex, and type of stress performed) Cox survival curve in patients with normal ^99mTc-tetrofosmin SPECT. Over 30 mo of follow-up, cumulative survival was 98.6%.

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FIGURE 2. Risk-adjusted (controlling for age, sex, and type of stress performed) Cox survival curve in normal ^99mTc-tetrofosmin SPECT by age of patient. Scatter plot of predicted survival by patient age is depicted. As patient age increases, there is general decline in 30-mo survival. Because of increasing comorbidity, risk factors, and disease prevalence, at $>=$ 73 y old, there is substantial increase in mortality in patients with normal ^99mTc-tetrofosmin SPECT.

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FIGURE 3. Risk-adjusted (controlling for age, sex, and type of stress performed) Cox survival curve in patients with normal ²⁰¹Tl, ^99mTc-sestamibi, and ^99mTc-tetrofosmin SPECT. Similar survival rates were noted for all 3 isotopes—that is, at 3 y, $>=$ 98% of patients with normal or low-risk perfusion scan were alive.

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FIGURE 4. Meta-analysis of annualized cardiac death rates in normal or low-risk ²⁰¹Tl, ^99mTc-sestamibi, and ^99mTc-tetrofosmin SPECT. Published evidence in large observational series of $>=$ 1,000 or in prior multicenter registries is depicted. Of 4 published reports ((7–9) and this study) in $~$ 30,000 patients, survival in patients with normal or low-risk scan exceeded 99.3%/y. Meta-analysis revealed that annualized cardiac death rate was 99.5% (95% CI = 99.3%–99.7%).