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

Publication ,  Journal Article
Dorbala, S; Di Carli, MF; Beanlands, RS; Merhige, ME; Williams, BA; Veledar, E; Chow, BJW; Min, JK; Pencina, MJ; Berman, DS; Shaw, LJ
Published in: J Am Coll Cardiol
January 15, 2013

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.

Duke Scholars

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 15, 2013

Volume

61

Issue

2

Start / End Page

176 / 184

Location

United States

Related Subject Headings

  • Stroke Volume
  • Rubidium Radioisotopes
  • Risk Assessment
  • Registries
  • Proportional Hazards Models
  • Prognosis
  • Positron-Emission Tomography
  • Myocardial Perfusion Imaging
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Dorbala, S., Di Carli, M. F., Beanlands, R. S., Merhige, M. E., Williams, B. A., Veledar, E., … Shaw, L. J. (2013). Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry. J Am Coll Cardiol, 61(2), 176–184. https://doi.org/10.1016/j.jacc.2012.09.043
Dorbala, Sharmila, Marcelo F. Di Carli, Rob S. Beanlands, Michael E. Merhige, Brent A. Williams, Emir Veledar, Benjamin J. W. Chow, et al. “Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry.J Am Coll Cardiol 61, no. 2 (January 15, 2013): 176–84. https://doi.org/10.1016/j.jacc.2012.09.043.
Dorbala S, Di Carli MF, Beanlands RS, Merhige ME, Williams BA, Veledar E, et al. Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry. J Am Coll Cardiol. 2013 Jan 15;61(2):176–84.
Dorbala, Sharmila, et al. “Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry.J Am Coll Cardiol, vol. 61, no. 2, Jan. 2013, pp. 176–84. Pubmed, doi:10.1016/j.jacc.2012.09.043.
Dorbala S, Di Carli MF, Beanlands RS, Merhige ME, Williams BA, Veledar E, Chow BJW, Min JK, Pencina MJ, Berman DS, Shaw LJ. Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry. J Am Coll Cardiol. 2013 Jan 15;61(2):176–184.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 15, 2013

Volume

61

Issue

2

Start / End Page

176 / 184

Location

United States

Related Subject Headings

  • Stroke Volume
  • Rubidium Radioisotopes
  • Risk Assessment
  • Registries
  • Proportional Hazards Models
  • Prognosis
  • Positron-Emission Tomography
  • Myocardial Perfusion Imaging
  • Middle Aged
  • Male