Abstract
505
Background: Although prior studies have examined prognostic performance of high-speed SPECT myocardial perfusion imaging (HS-MPI) using cadmium zinc telluride detectors, it has been limited to single centers and small cohorts. We studied the predictive value of fully automated myocardial perfusion analysis from a large cohort from 4 different centers.
Methods: We studied 15367 patients (64±12 years, 56% male) undergoing exercise or pharmacologic stress 99mTc-sestamibi HS-MPI and followed for 3.2 ± 1.6 years for adverse major cardiac event (MACE). Automated quantitative software was used to compute stress total perfusion deficit (sTPD). MPI was classified as sTPD=0%, 0<sTPD<1, 1≤sTPD<3, 3≤sTPD<5 5≤sTPD<10, 10≤sTPD<20 and 20≤sTPD. MACE consisted of all-cause mortality, nonfatal myocardial infarction, unstable angina, or late coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting). Kaplan Meier and Cox proportional hazards analysis were performed to test the performance of sTPD to predict MACE. Annualized MACE rate was compared between male and female. RESULTS: During follow-up, 1461 MACE occurred (9.5%). Annualized MACE rate increased with progressively increasing sTPD; sTPD=0% (1.1%), 0<sTPD<1 (1.7%),1≤sTPD<3 (2.3%), 3≤sTPD<5 (2.9%), 5≤sTPD<10 (4.5%), 10≤sTPD<20 (7.1%), and 20≤sTPD (9.6%) (log-rank P<0.0001, Figure). Similarly, the annualized MACE rate in male and female increased with progressively increasing sTPD; sTPD=0% (0.9% in female vs 1.6% male, P=0.15), 0<sTPD<1 (1.4% in female vs 2.0% male, P=0.05), 1≤sTPD<3 (2.0% in female vs 2.5% male, P=0.03), 3≤sTPD<5 (2.5% in female vs 3.2% male, P= 0.04), 5≤sTPD<10 (4.1% in female vs 4.7% male, P=0.08), 10≤sTPD<20 (6.6% in female vs 7.3% male, P=0.18), and 20≤sTPD (13.2% in female vs 8.9% male, P=0.04), (log-rank P for both<0.0001, Figure). CONCLUSIONS: By quantitative analysis, MACE increases progressively with increasing perfusion abnormality among patients undergoing stress HS-MPI in all, male and female. Differences in MACE rate exist between female and male populations with the same quantitative MPS results.
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