Nomograms for estimating coronary artery disease prognosis with gated stress myocardial perfusion SPECT

CAD death or MI rates worsened in a gradient manner by the % ischemic myocardium. Higher risk patients were those with a rest and/or post-stress LVEF ≤ 45%. A nomogram was developed to estimate 2-year CAD death or MI-free survival for exercising and pharmacologic stress patients by their post-stress LVEF and % ischemic myocardium MPS results. Patients undergoing pharmacologic stress with a rest and/or post-stress LVEF ≤ 45% with high risk ischemic findings had the lowest CAD death or MI event-free survival. For exercising patients with a preserved resting LVEF > 45%, 2-year CAD death or MI event-free survival ranged from 99.4% to 89% for 0% to ≥20% ischemic myocardium. Those at highest risk included patients undergoing pharmacologic stress with depressed LVEF. For pharmacologic stress patients with a resting LVEF ≤45%, 2-year CAD death or MI event-free survival ranged from 89% to 48% for 0% to ≥20% ischemic myocardium. For pharmacologic stress patients with a post-stress LVEF ≤ 45%, 2-year CAD death or MI event-free survival ranged from 88% to 46% for 0% to ≥20% ischemic myocardium. A validation cohort revealed moderate-strong correlation between observed and predicted survival (r = 0.71). Average discordance between observed and predicted survival was ≤2% but was greater for higher risk patients with lower predicted survival estimates.