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OtherCLINICAL INVESTIGATIONS

Prediction of Myocardial Infarction Versus Cardiac Death by Gated Myocardial Perfusion SPECT: Risk Stratification by the Amount of Stress-Induced Ischemia and the Poststress Ejection Fraction

Tali Sharir, Guido Germano, Xingping Kang, Howard C. Lewin, Romalisa Miranda, Ishac Cohen, Raluca D. Agafitei, John D. Friedman and Daniel S. Berman
Journal of Nuclear Medicine June 2001, 42 (6) 831-837;
Tali Sharir
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Guido Germano
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Xingping Kang
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Howard C. Lewin
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Romalisa Miranda
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Ishac Cohen
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Raluca D. Agafitei
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John D. Friedman
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Daniel S. Berman
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  • FIGURE 1.
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    FIGURE 1.

    Univariate (A and B) and multivariate (C) Cox regression analysis for prediction of CD and nonfatal MI. LK = prescan likelihood of coronary disease; DM = diabetes mellitus. *P < 0.02. **P < 0.001.

  • FIGURE 2.
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    FIGURE 2.

    Annual CD rate as function of EF. Number of patients at each 10% interval is indicated in parentheses.

  • FIGURE 3.
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    FIGURE 3.

    Cumulative survival with stratification by EF. Number of patients in each subgroup is indicated.

  • FIGURE 4.
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    FIGURE 4.

    Nonfatal MI rate as function of SDS. Number of patients at each 5-unit interval is indicated.

  • FIGURE 5.
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    FIGURE 5.

    Cumulative hazard of nonfatal MI with stratification by presence or absence of ischemia. Number of patients in each subgroup is indicated.

  • FIGURE 6.
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    FIGURE 6.

    CD rate as function of amount of ischemia in patients with EF >50% and EF between 30% and 50% (A) and in patients with EF <30% (B). Mod = moderate. *P < 0.05 vs. EF >50% in same perfusion category. **P < 0.005 compared with no ischemia and same EF category.

  • FIGURE 7.
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    FIGURE 7.

    Risk stratification by poststress EF and amount of stress-induced ischemia.

Tables

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    TABLE 1

    Patient Characteristics

    Parametern (%)
    Patients2,686
    Age (y)66 ± 12
    Males1,636  (60.9)
    Exercise1,678  (62)
    Symptoms
        Typical angina403  (15)
        Atypical angina798  (29.7)
    History of MI698  (26)
    History of coronary angioplasty518  (19.3)
    History of bypass surgery525  (19.5)
    Diabetes mellitus313  (12)
    Hypertension1,284  (47.8)
    Current smoking259  (9.6)
    Prescan likelihood of CAD0.38 ± 0.31
    Abnormal perfusion at stress1,440  (53.9)
    Reversible perfusion defect1,261  (47)
    EF58 ± 5
    CD57  (2.12)
    MI30  (1.12)
    • View popup
    TABLE 2

    Multivariate Cox Proportional Hazards Analysis: Best Models for Prediction of MI and CD

    Parameterβ coefficientSEWald χ2P
    MI
        SDS0.080.0217.03<0.0001
        Prescan likelihood of CAD1.740.686.550.01
    CD
        EF−0.050.0124.35<0.0001
        Adenosine stress1.220.3511.890.0006
        Prescan likelihood of CAD1.570.645.970.02
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Journal of Nuclear Medicine: 42 (6)
Journal of Nuclear Medicine
Vol. 42, Issue 6
June 1, 2001
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Prediction of Myocardial Infarction Versus Cardiac Death by Gated Myocardial Perfusion SPECT: Risk Stratification by the Amount of Stress-Induced Ischemia and the Poststress Ejection Fraction
Tali Sharir, Guido Germano, Xingping Kang, Howard C. Lewin, Romalisa Miranda, Ishac Cohen, Raluca D. Agafitei, John D. Friedman, Daniel S. Berman
Journal of Nuclear Medicine Jun 2001, 42 (6) 831-837;

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Prediction of Myocardial Infarction Versus Cardiac Death by Gated Myocardial Perfusion SPECT: Risk Stratification by the Amount of Stress-Induced Ischemia and the Poststress Ejection Fraction
Tali Sharir, Guido Germano, Xingping Kang, Howard C. Lewin, Romalisa Miranda, Ishac Cohen, Raluca D. Agafitei, John D. Friedman, Daniel S. Berman
Journal of Nuclear Medicine Jun 2001, 42 (6) 831-837;
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