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01-06-2016 | Original Article

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

Authors: Rine Nakanishi, MD, PhD, Heidi Gransar, MS, Piotr Slomka, PhD, Reza Arsanjani, MD, Aryeh Shalev, MD, Yuka Otaki, MD, PhD, John D. Friedman, MD, Sean W. Hayes, MD, Louise E. B. Thomson, MBChB, Mathews Fish, MD, Guido Germano, PhD, Aiden Abidov, MD, PhD, Leslee Shaw, PhD, Alan Rozanski, MD, Daniel S. Berman, MD, FACC

Published in: Journal of Nuclear Cardiology | Issue 3/2016

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.

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Title: Predictors of high-risk coronary artery disease in subjects with normal SPECT myocardial perfusion imaging
Authors: Rine Nakanishi, MD, PhD
Heidi Gransar, MS
Piotr Slomka, PhD
Reza Arsanjani, MD
Aryeh Shalev, MD
Yuka Otaki, MD, PhD
John D. Friedman, MD
Sean W. Hayes, MD
Louise E. B. Thomson, MBChB
Mathews Fish, MD
Guido Germano, PhD
Aiden Abidov, MD, PhD
Leslee Shaw, PhD
Alan Rozanski, MD
Daniel S. Berman, MD, FACC
Publication date: 01-06-2016
Publisher: Springer US
Published in: Journal of Nuclear Cardiology / Issue 3/2016
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-015-0150-3

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