Myocardial Perfusion Imaging Is a Strong Predictor of Death in Women

• Published in: JACC. Cardiovascular imaging 2011-08, Vol.4 (8), p.880-888
• Main Authors: Cerci, Mario Sergio Julio, MD, MPH, Cerci, Juliano Julio, MD, PhD, Cerci, Rodrigo Julio, MD, Cunha Pereira Neto, Carlos, MD, Trindade, Evelinda, MD, PhD, Delbeke, Dominique, MD, PhD, Pereira da Cunha, Claudio L., MD, PhD, Vitola, João Vicente, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Analysis of Variance; Brazil; Cardiovascular; Chi-Square Distribution; Coronary Circulation; Female; Heart Diseases - diagnostic imaging; Heart Diseases - mortality; Heart Diseases - physiopathology; Humans; Kaplan-Meier Estimate; Middle Aged; Myocardial Perfusion Imaging - methods; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk Factors; Sex Factors; Stroke Volume; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2011.06.009

Objectives We sought to assess the prognostic value and risk classification improvement using contemporary single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) to predict all-cause mortality. Background Myocardial perfusion is a strong estimator of prognosis. Evidence published to date has not established the added prognostic value of SPECT-MPI nor defined an approach to detect improve classification of risk in women from a developing nation. Methods A total of 2,225 women referred for SPECT-MPI were followed by a mean period of 3.7 ± 1.4 years. SPECT-MPI results were classified as abnormal on the presence of any perfusion defect. Abnormal scans were further classified as with mild/moderate reversible, severe reversible, partial reversible, or fixed perfusion defects. Risk estimates for incident mortality were categorized as 2%/year using Cox proportional hazard models. Risk-adjusted models incorporated clinical risk factors, left ventricular ejection fraction (LVEF), and perfusion variables. Results All-cause death occurred in 139 patients. SPECT-MPI significantly risk stratified the population; patients with abnormal scans had significantly higher death rates compared with patients with normal scans, 13.1% versus 4.0%, respectively (p < 0.001). Cox analysis demonstrated that after adjusting for clinical risk factors and LVEF, SPECT-MPI improved the model discrimination (integrated discrimination index = 0.009; p = 0.02), added significant incremental prognostic information (global chi-square increased from 87.7 to 127.1; p < 0.0001), and improved risk prediction (net reclassification improvement = 0.12; p = 0.005). Conclusions SPECT-MPI added significant incremental prognostic information to clinical and left ventricular functional variables while enhancing the ability to classify this Brazilian female population into low- and high-risk categories of all-cause mortality.