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Multicenter Study
. 2013 Jan 15;61(2):176-84.
doi: 10.1016/j.jacc.2012.09.043. Epub 2012 Dec 5.

Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry

Sharmila Dorbala  1 , Marcelo F Di Carli, Rob S Beanlands, Michael E Merhige, Brent A Williams, Emir Veledar, Benjamin J W Chow, James K Min, Michael J Pencina, Daniel S Berman, Leslee J Shaw
Affiliations
Multicenter Study

Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry

Sharmila Dorbala et al. J Am Coll Cardiol. .

Abstract

Objectives: The primary objective of this multicenter registry was to study the prognostic value of positron emission tomography (PET) myocardial perfusion imaging (MPI) and the improved classification of risk in a large cohort of patients with suspected or known coronary artery disease (CAD).

Background: Limited prognostic data are available for MPI with PET.

Methods: A total of 7,061 patients from 4 centers underwent a clinically indicated rest/stress rubidium-82 PET MPI, with a median follow-up of 2.2 years. The primary outcome of this study was cardiac death (n = 169), and the secondary outcome was all-cause death (n = 570). Net reclassification improvement (NRI) and integrated discrimination analyses were performed.

Results: Risk-adjusted hazard of cardiac death increased with each 10% myocardium abnormal with mildly, moderately, or severely abnormal stress PET (hazard ratio [HR]: 2.3 [95% CI: 1.4 to 3.8; p = 0.001], HR: 4.2 [95% CI: 2.3 to 7.5; p < 0.001], and HR: 4.9 [95% CI: 2.5 to 9.6; p < 0.0001], respectively [normal MPI: referent]). Addition of percent myocardium ischemic and percent myocardium scarred to clinical information (age, female sex, body mass index, history of hypertension, diabetes, dyslipidemia, smoking, angina, beta-blocker use, prior revascularization, and resting heart rate) improved the model performance (C-statistic 0.805 [95% CI: 0.772 to 0.838] to 0.839 [95% CI: 0.809 to 0.869]) and risk reclassification for cardiac death (NRI 0.116 [95% CI: 0.021 to 0.210]), with smaller improvements in risk assessment for all-cause death.

Conclusions: In patients with known or suspected CAD, the extent and severity of ischemia and scar on PET MPI provided powerful and incremental risk estimates of cardiac death and all-cause death compared with traditional coronary risk factors.

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Figures

Figure 1
Figure 1. Unadjusted Hazard of Events by % Abnormal Myocardium on Vasodilator Stress Rb-82 PET
Hazard of cardiac-death (A, 6, 037 patients, N= 169 cardiac-deaths) and all-cause death (B, 7,061 patients, N=570 all-cause deaths) was lowest in patients with normal PET MPI and increased gradually in patients with minimal, mild, moderate or severe degrees of scan abnormality.
Figure 1
Figure 1. Unadjusted Hazard of Events by % Abnormal Myocardium on Vasodilator Stress Rb-82 PET
Hazard of cardiac-death (A, 6, 037 patients, N= 169 cardiac-deaths) and all-cause death (B, 7,061 patients, N=570 all-cause deaths) was lowest in patients with normal PET MPI and increased gradually in patients with minimal, mild, moderate or severe degrees of scan abnormality.
Figure 2
Figure 2. Risk-Adjusted Hazard of Events by % Abnormal Myocardium on Vasodilator Stress Rb-82 PET
Hazard of cardiac-death (A, 6, 037 patients, N= 169 cardiac-deaths)and all-cause death (B, 7,061 patients, N=570 all-cause deaths) was lowest in patients with normal PET MPI and increased gradually in patients with minimal, mild, moderate or severe degrees of scan abnormality.
Figure 2
Figure 2. Risk-Adjusted Hazard of Events by % Abnormal Myocardium on Vasodilator Stress Rb-82 PET
Hazard of cardiac-death (A, 6, 037 patients, N= 169 cardiac-deaths)and all-cause death (B, 7,061 patients, N=570 all-cause deaths) was lowest in patients with normal PET MPI and increased gradually in patients with minimal, mild, moderate or severe degrees of scan abnormality.
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References

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