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

• 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
• Journal Title: Journal of Nuclear Cardiology
• Volume: Volume 23, Number 3
• Publisher: Springer Verlag (Germany) | 2016-06-01, Pages 530-541
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1007/s12350-015-0150-3
• Subjects: Health Sciences, Radiology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Radiology, Nuclear Medicine & Medical Imaging; Cardiovascular System & Cardiology; Single-photon emission computed tomography myocardial perfusion imaging; SPECT-MPI; High risk of coronary artery disease; EMISSION COMPUTED-TOMOGRAPHY; TRANSIENT ISCHEMIC DILATION; INCREMENTAL PROGNOSTIC VALUE; AMERICAN-HEART-ASSOCIATION; HEALTH-CARE PROFESSIONALS; FRACTIONAL FLOW RESERVE; ALL-CAUSE MORTALITY; LEFT-VENTRICLE; EJECTION FRACTION; LARGE POPULATION

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.