Prediction of Death and Nonfatal Myocardial Infarction in High-Risk Patients: A Comparison Between the Duke Treadmill Score, Peak Exercise Radionuclide Angiography, and SPECT Perfusion Imaging

Article Figures & Data

TABLE 1

Baseline Characteristics

Characteristic	CV death (n = 87)*	Nonfatal MI (n = 59)*	All patients (n = 997)
Median age^† (y) [25th, 75th]	61 [51, 68]	63 [55, 71]	60 [52, 68]
Male^‡	59 (68)	44 (75)	751 (75)
White^‡	77 (89)	51 (86)	885 (89)
Diabetes^‡	33 (38)	30 (51)	223 (22)
History of smoking^‡	61 (70)	39 (66)	663 (66)
Hypertension^‡	61 (70)	43 (73)	619 (62)
Peripheral vascular disease^‡	11 (13)	14 (24)	118 (12)
Cerebrovascular disease^‡	14 (16)	15 (25)	155 (16)
Carotid bruits^‡	11 (13)	9 (15)	104 (10)
History of angina^‡	73 (84)	54 (92)	860 (86)
CHF^‡	47 (54)	19 (32)	328 (33)
NYHA class IV CHF^‡	4 (5)	1 (2)	18 (2)
Previous PCI^‡	30 (35)	26 (44)	363 (36)
Previous CABG^‡	38 (44)	44 (75)	451 (45)
Prior MI^‡	44 (51)	37 (63)	435 (44)
No. of diseased vessels^‡
0	18 (22)	3 (5)	284 (29)
1	17 (21)	11 (19)	217 (22)
2	25 (29)	14 (24)	195 (20)
3	23 (28)	31 (52)	280 (29)
Median SSS^† (25th, 75th)	6 (0, 12)	7 (3, 10)	3 (0, 9)
Median DTS^† (25th, 75th)	3 (0, 4.5)	2.6 (−1.5, 4.4)	4 (0, 6)
Median first-pass RNA-EF^† (25th, 75th)	44 (33, 56)	55 (39, 61)	56 (45, 65)

↵* Ten nonfatal MI patients also experienced cardiovascular (CV) death at later date.
↵^† Median with 25th and 75th percentiles in brackets or parentheses.
↵^‡ Median with percentage in parentheses.
CHF = congestive heart failure; PCI = percutaneous coronary intervention; CABG = coronary artery bypass graft.

TABLE 2

Models for All-Cause Death

Parameter	Unadjusted			Adjusted for baseline hazard score
Parameter		Model χ²	Model P value	Model χ²	Incremental P value*
RNA-EF	22.4	0.0001	36.4	0.0001
DTS	21.5	0.0001	34.3	0.0003
SSS	2.2	NS	22.4	NS
SRS	3.1	NS	23.0	NS
SDS	0.032	NS	21.3	NS
Baseline hazard score	21.3	0.0001

TABLE 3

Complete Models for All Endpoints

Endpoint	Variable	All patients (n = 997)			Without early revascularization (n = 936)
Endpoint	Variable			Wald χ²	P value	Wald χ²	P value
All-cause death	Baseline hazard	8.5	0.0036	7.9	0.0049
	DTS	7.0	0.0080	6.8	0.0089
	RNA-EF	15.7	0.0001	16.4	0.0001
	SSS	2.8	NS	3.2	NS
CV death	Baseline hazard	3.1	NS	3.0	NS
	DTS	6.0	0.014	5.8	0.016
	RNA-EF	19.0	0.0001	18.2	0.0001
	SSS	0.8	NS	0.9	NS
Nonfatal MI	Baseline hazard	11.2	0.0008	4.2	0.039
	DTS	1.0	NS	0.3	NS
	RNA-EF	0.3	NS	2.2	NS
	SSS*	9.2	0.0101	0.0	NS
CV death or nonfatal MI	Baseline hazard	10.8	0.0010	6.0	0.014
	DTS	6.1	0.014	4.6	0.03
	RNA-EF	14.5	0.0001	17.9	0.0001
	SSS	0.2	NS	0.8	NS

↵* SSS included as 2 variables to meet linearity-in-hazard assumption for Cox model.
NS = not significant; CV = cardiovascular.

TABLE 4

Models for Cardiovascular Death

Parameter	Unadjusted			Adjusted for baseline hazard score
Parameter		Model χ²	Model P value	Model χ²	Incremental P value*
RNA-EF	34.5	0.0001	40.5	0.0001
DTS	19.9	0.0001	27.6	0.0002
SSS	8.1	0.0044	19.8	0.0151
SRS	8.3	0.0041	19.7	0.0160
SDS	0.3	NS	14.2	NS
Baseline hazard score	13.9	0.0001

TABLE 5

Models for Nonfatal MI

Parameter	Unadjusted			Adjusted for baseline hazard score
Parameter		Model χ²	Model P value	Model χ²	Incremental P value*
RNA-EF	6.2	0.0126	16.7	NS
DTS	3.1	NS	15.7	NS
SSS	14.8	0.0006	26.7	0.0003
SRS	2.2	NS	14.4	NS
SDS	3.2	NS	17.0	NS
Baseline hazard score	13.6	0.0001

TABLE 6

Models for Cardiovascular Death or Nonfatal MI

Parameter	Unadjusted			Adjusted for baseline hazard score
Parameter		Model χ²	Model P value	Model χ²	Incremental P value*
RNA-EF	34.0	0.0001	48.4	0.0001
DTS	18.9	0.0001	35.6	0.0009
SSS	11.5	0.0007	31.8	0.0073
SRS	10.3	0.0013	30.4	0.0160
SDS	1.1	NS	25.9	NS
Baseline hazard score	24.6	0.0001