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Improved near-term coronary artery disease risk classification with gated stress myocardial perfusion SPECT.

Publication ,  Journal Article
Shaw, LJ; Wilson, PWF; Hachamovitch, R; Hendel, RC; Borges-Neto, S; Berman, DS
Published in: JACC Cardiovasc Imaging
November 2010

OBJECTIVES: We compared analytical approaches to estimate the added value of myocardial perfusion single-photon emission computed tomography (MPS) variables in estimating coronary artery disease (CAD) outcomes. BACKGROUND: Stress MPS markers of regional ischemia are strong estimators of prognosis. Evidence published to date has not compared analytical methods to establish the added value of stress MPS and to define a clinically meaningful approach to detect improve classification of risk. METHODS: A total of 4,575 patients were consecutively and prospectively enrolled in the Myoview Prognosis Registry. Multivariable Cox proportional hazards model were employed to estimate CAD death or myocardial infarction (MI). Risk reclassification methods were also calculated. RESULTS: In risk-adjusted models (including age, sex, presenting symptoms, stress type, CAD history, and risk factors), stress MPS ischemia, rest and post-stress left ventricular ejection fraction (LVEF) (all p < 0.0001) were all significant estimators of CAD death or MI. In this multivariable model, 34% of the model chi-square was contributed by MPS ischemia. In receiver-operating characteristic curve analysis, the area under the curve increased from 0.61 to 0.66 when rest and post-stress LVEF were combined with pre-test CAD likelihood (p < 0.0001), increasing to 0.69 for MPS ischemia (p < 0.0001). The net reclassification improvement (NRI) by adding the Duke Treadmill Score (DTS) to a model including pre-test CAD likelihood was 0.112. The cost per NRI was $57 for the exercise test as compared with an office visit for risk stratification purposes. Further, the NRI by adding MPS ischemia to a model with the DTS and pre-test CAD likelihood was 0.358. The cost per NRI was $615 for the stress MPS as compared with an exercise test. CONCLUSIONS: Stress-induced ischemia is independently predictive of near-term CAD outcomes. Analytical approaches that establish the reclassification of events provide a unique approach and may serve as a quality imaging metric for estimation of improved health outcomes for stress MPS as well as for comparison to other imaging modalities.

Duke Scholars

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

November 2010

Volume

3

Issue

11

Start / End Page

1139 / 1148

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Tomography, Emission-Computed, Single-Photon
  • Stroke Volume
  • Risk Factors
  • Risk Assessment
  • Registries
  • ROC Curve
  • Prospective Studies
  • Proportional Hazards Models
  • Prognosis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Shaw, L. J., Wilson, P. W. F., Hachamovitch, R., Hendel, R. C., Borges-Neto, S., & Berman, D. S. (2010). Improved near-term coronary artery disease risk classification with gated stress myocardial perfusion SPECT. JACC Cardiovasc Imaging, 3(11), 1139–1148. https://doi.org/10.1016/j.jcmg.2010.09.008
Shaw, Leslee J., Peter W. F. Wilson, Rory Hachamovitch, Robert C. Hendel, Salvador Borges-Neto, and Daniel S. Berman. “Improved near-term coronary artery disease risk classification with gated stress myocardial perfusion SPECT.JACC Cardiovasc Imaging 3, no. 11 (November 2010): 1139–48. https://doi.org/10.1016/j.jcmg.2010.09.008.
Shaw LJ, Wilson PWF, Hachamovitch R, Hendel RC, Borges-Neto S, Berman DS. Improved near-term coronary artery disease risk classification with gated stress myocardial perfusion SPECT. JACC Cardiovasc Imaging. 2010 Nov;3(11):1139–48.
Shaw, Leslee J., et al. “Improved near-term coronary artery disease risk classification with gated stress myocardial perfusion SPECT.JACC Cardiovasc Imaging, vol. 3, no. 11, Nov. 2010, pp. 1139–48. Pubmed, doi:10.1016/j.jcmg.2010.09.008.
Shaw LJ, Wilson PWF, Hachamovitch R, Hendel RC, Borges-Neto S, Berman DS. Improved near-term coronary artery disease risk classification with gated stress myocardial perfusion SPECT. JACC Cardiovasc Imaging. 2010 Nov;3(11):1139–1148.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

November 2010

Volume

3

Issue

11

Start / End Page

1139 / 1148

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Tomography, Emission-Computed, Single-Photon
  • Stroke Volume
  • Risk Factors
  • Risk Assessment
  • Registries
  • ROC Curve
  • Prospective Studies
  • Proportional Hazards Models
  • Prognosis