TY - JOUR T1 - Improved Outcome Prediction by SPECT Myocardial Perfusion Imaging After CT Attenuation Correction JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 196 LP - 200 DO - 10.2967/jnumed.110.080580 VL - 52 IS - 2 AU - Aju P. Pazhenkottil AU - Jelena-Rima Ghadri AU - Rene N. Nkoulou AU - Mathias Wolfrum AU - Ronny R. Buechel AU - Silke M. Küest AU - Lars Husmann AU - Bernhard A. Herzog AU - Oliver Gaemperli AU - Philipp A. Kaufmann Y1 - 2011/02/01 UR - http://jnm.snmjournals.org/content/52/2/196.abstract N2 - The aim of this study was to determine the impact of attenuation correction with CT (CT-AC) on the prognostic value of SPECT myocardial perfusion imaging (SPECT MPI). Methods: The summed stress score (SSS; 20-segment model) was obtained from filtered backprojection (FBP) and iterative reconstruction with CT-AC in 876 consecutive patients undergoing a 1-d stress–rest 99mTc-tetrofosmin SPECT MPI study for the evaluation of known or suspected coronary artery disease. Survival free of major adverse cardiac events (MACEs; cardiac death or nonfatal myocardial infarction) and survival free of any adverse cardiac events (including cardiac hospitalization, unstable angina, and late coronary revascularization) were analyzed by Kaplan–Meier analysis. Results: At a mean follow-up of 2.3 ± 0.6 y, a total of 184 adverse events occurred in 145 patients, including 35 MACEs (16 cardiac deaths [rate, 1.8%] and 19 nonfatal myocardial infarctions [rate, 2.2%]). With FBP, an SSS of 0–3 best distinguished patients with a low MACE rate (0.6%), followed by an SSS of 4–8 (4.3%), with increased MACE rate, and an SSS of 9–13 (3.8%), which was comparable. By contrast, with CT-AC the discrimination of low from intermediate MACE rate was best observed between an SSS of 0 (0%) and an SSS of 1–3 (3.7%), with a plateau at an SSS of 4–8 (3.2%). Conclusion: CT-AC for SPECT MPI allows improved risk stratification. The prognostically relevant SSS cutoff is shifted toward lower values. ER -