Predictors of high-risk coronary artery disease in subjects with normal SPECT myocardial perfusion imaging

• Type of Material: Article
• Authors: Rine Nakanishi, Cedars Sinai Medical Center; Heidi Gransar, Cedars Sinai Medical Center; Piotr Slomka, Cedars Sinai Medical Center; Reza Arsanjani, Cedars Sinai Medical Center; Aryeh Shalev, Cedars Sinai Medical Center; Yuka Otaki, Cedars Sinai Medical Center; John D. Friedman, Cedars Sinai Medical Center; Sean W. Hayes, Cedars Sinai Medical Center; Louise E. B. Thomson, Cedars Sinai Medical Center; Mathews Fish, Cedars Sinai Medical Center; Guido Germano, Cedars Sinai Medical Center; Aiden Abidov, University of Arizona; Leslee J Shaw, Emory University; Alan Rozanski, St. Lukes Roosevelt Hospital; Daniel S. Berman, Cedars Sinai Medical Center
• Language: English
• Date: 2016-06-01
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015, American Society of Nuclear Cardiology.
• Final Published Version (URL): http://dx.doi.org/10.1007/s12350-015-0150-3
• Title of Journal or Parent Work: Journal of Nuclear Cardiology
• ISSN: 1071-3581
• Volume: 23
• Issue: 3
• Start Page: 530
• End Page: 541
• Grant/Funding Information: This work was also supported by grants to Dr. Berman from the Jane and Michael Eisner, and the Diane and Guilford Glazer Foundations.; Dr. Nakanishi was supported in part by research fellowship awards from the Society of Nuclear Medicine and Toho University School of Medicine, Tokyo, Japan.; This research was supported in part by grants R01HL089765 and 5K23HL92299 from the National Heart, Lung, and Blood Institute/National Institutes of Health (NHLBI/NIH).
• Keywords: INCREMENTAL PROGNOSTIC VALUE; Single-photon emission computed tomography myocardial perfusion imaging; High risk of coronary artery disease; SPECT-MPI; EJECTION FRACTION; LEFT-VENTRICLE; Science & Technology; Cardiac & Cardiovascular Systems; TRANSIENT ISCHEMIC DILATION; Cardiovascular System & Cardiology; LARGE POPULATION; AMERICAN-HEART-ASSOCIATION; EMISSION COMPUTED-TOMOGRAPHY; FRACTIONAL FLOW RESERVE; ALL-CAUSE MORTALITY; HEALTH-CARE PROFESSIONALS; Life Sciences & Biomedicine; Radiology, Nuclear Medicine & Medical Imaging
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Radiology

Abstract

Background: While uncommon, normal stress SPECT myocardial perfusion imaging (MPI) can be seen in patients with high-risk coronary artery disease (CAD) by invasive coronary angiography (ICA).The predictors of high-risk CAD in patients with normal SPECT-MPI have not been described. Methods: We studied 580 patients (age 64 ± 12 years, 49% men) without known CAD who underwent stress-gated SPECT-MPI [exercise (41%) or vasodilator (59%)] <2 months before ICA and had summed stress score (SSS) <4. High-risk CAD was defined as 3 vessels with ≥70% stenosis, 2 vessels with ≥70% stenosis including proximal left anterior descending, or left main with ≥50% stenosis. Obstructive non-high-risk CAD was defined by the presence of a ≥70% stenosis but without having other high-risk criteria. Tenfold cross-validated receiver operating characteristic (ROC) estimates were obtained to assess the predictors of high-risk CAD. Results: Forty-two subjects (7.2%) had high-risk CAD and 168 (29.0%) had obstructive non-high-risk CAD. Variables associated with high-risk CAD were pretest probability of CAD ≥66% (Odds ratio [OR] 3.63, 95% CI 1.6-8.3, P = .002), SSS > 0 (OR 7.46, 95% CI 2.6-21.1, P < 0.001), and abnormal TID (OR 2.16, 95% CI 1.0-4.5, P = 0.044). When substituted for TID, EF change was also predictive of high-risk CAD (OR 0.93, 95% CI 0.9-1.0, P = 0.023). The prevalence of high-risk CAD increased as the number of these predictors increased. In a sub-analysis of patients in whom quantitative total perfusion deficit (TPD) was available, TPD > 0 was also a predictor of high-risk CAD (OR 6.01, 95% CI 1.5-22.2, P = 0.011). Conclusion: Several clinical, stress, and SPECT-MPI findings are associated high-risk CAD among patients with normal SPECT-MPI. Consideration of these factors may improve the overall assessment of the likelihood of high-risk CAD in patients undergoing stress SPECT-MPI.