Influence of 99mTc-tetrofosmin SPECT myocardial perfusion imaging on the prediction of future adverse cardiac events

Abstract

BackgroundThe impact of myocardial perfusion imaging (MPI) on prediction of risk for future cardiac events was examined by comparing predictions based on clinical information alone and in combination with MPI findings. Methods and ResultsA 3-cardiologist Cardiac Event Prediction Panel (CEPP) estimated three-year cardiac event (non-fatal MI; aborted sudden cardiac death; cardiac death) risk based on clinical data (C) for 371 subjects. CEPP repeated this estimation after receiving Summed Stress Scores (SSS) and Summed Rest Scores (SRS) from blinded reading of rest-stress 99mTc-tetrofosmin MPI SPECT studies (C + MPI). The C and C + MPI estimates were then compared with three-year and total event rates. MPI was normal (SSS ≤ 3) in 227 patients (61%), mildly abnormal (SSS 4-8) in 31 (8%), moderately abnormal (SSS 9-13) in 36 (10%), and severely abnormal (SSS > 13) in 77 (21%). Eighteen cardiac events occurred within 3 years and 33 occurred during a mean follow-up of 3.9 years. C + MPI estimates of low risk (<1-1.5%/year) identified significantly more patients who did not have events than C. C + MPI three-year event-rate predictions were more accurate than those made with C (P < .01). C + MPI categorization also provided better delineation of incremental risk on time-to-event analyses. Conclusions99mTc-tetrofosmin MPI single photon emission computed tomography (SPECT) findings significantly improve accuracy of cardiac event rate prediction compared to those based on clinical information alone.