OtherClinical Investigations

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

Leslee J. Shaw, Robert Hendel, Salvador Borges-Neto, Michael S. Lauer, Naomi Alazraki, Joy Burnette, Elizabeth Krawczynska, Manuel Cerqueira, Jamshid Maddahi and ; for the Myoview Multicenter Registry
Journal of Nuclear Medicine February 2003, 44 (2) 134-139;

Article Figures & Data

Figures

  • FIGURE 1.
    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%.

  • FIGURE 2.
    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.

  • FIGURE 3.
    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.

  • FIGURE 4.
    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%).

Tables

  • TABLE 1

    Clinical Characteristics of Study Population (n = 4,728 Patients)

    CharacteristicValue
    Age (y; mean ± SD)61 ± 13
    Male sex (%)52
    Chest pain (%)
     Typical angina54
     Atypical angina35
    Known CAD (%)33
    Family history of CAD (%)40
    Hyperlipidemia (%)34
    Hypertension (%)50
    Diabetes (%)16
    Smoking (%)23
    History of cerebrovascular disease or peripheral arterial disease (%)12

    • CAD = coronary artery disease.

  • TABLE 2

    Exercise and SPECT Characteristics of Study Population (n = 4,728 Patients)

    CharacteristicValue
    Intravenous adenosine stress (%)33
    Total exercise time (min; mean ± SD)8.6 ± 7
    ECG response to stress (%)
     Nonischemic79
     Ischemic12
     Nondiagnostic9
     Equivocal1
    Exertional chest pain (%)19

    • ECG = electrocardiographic.

  • TABLE 3

    Average 30-Month Survival in Key Patient Subsets Including Women, Men, Exercise, Known Coronary Disease, and Type of Stress (Intravenous Adenosine or Exercise) 99mTc-Tetrofosmin SPECT

    Key patient subset30-Month cardiac survival (%)Variation (%) from average (99.4%)
    Sex
     Women99.4−0.0
     Men98.8−0.6
    Prior CAD history
     Known CAD98.7−0.7
     Prior MI98.6−0.8
     Prior CABG99.4−0.0
    Type of stress
     Intravenous adenosine99.3−0.1
     Exercise99.7+0.3

    • CAD = coronary artery disease; MI = myocardial infarction; CABG = coronary artery bypass graft.

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