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Determinants of risk and its temporal variation in patients with normal stress myocardial perfusion scans

What is the warranty period of a normal scan?

Rory Hachamovitch, MD, MSc, FACC^*, Sean Hayes, MD, John D. Friedman, MD, FACC, Ishac Cohen, PhD, Leslee J. Shaw, PhD, Guido Germano, PhD, MBA, FACC and Daniel S. Berman, MD, FACC^,*

^* Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
Departments of Imaging (Division of Nuclear Medicine) and Medicine (Division of Cardiology), Cedars-Sinai Medical Center Burns and Allen Research Institute, Department of Medicine, UCLA School of Medicine, Los Angeles, California, USA
Atlanta Cardiovascular Research Institute, Atlanta, Georgia, USA

View larger version (25K): [in a new window]   Figure 1 Outline of patient selection. PTCA = percutaneous transluminal coronary angioplasty; SPECT = single photon emission computed tomography.

View larger version (11K): [in a new window]   Figure 2 Hard event rates (% per year) in women versus men, patients with versus without history (Hx) of previous coronary artery disease (CAD), and patients undergoing adenosine versus exercise stress. *p < 0.001.

View larger version (11K): [in a new window]   Figure 3 Hard event rates (% per year) in men (black bars) and women (white bars) with (right) versus without (left) diabetes. Numbers under bars represent number of patients within category. *p = 0.007. DM = diabetes mellitus.

View larger version (13K): [in a new window]   Figure 4 Hard event rates (% per year) in patients without (black bars) versus with (white bars) history of known coronary artery disease undergoing exercise (left) or adenosine (right) stress. Numbers under bars represent number of patients within category. *p < 0.001.

View larger version (15K): [in a new window]   Figure 5 Examples of predicted event rates in the first and second years after the index single photon emission computed tomography study. The top pair of bars represents first- and second-year event rates in a 50-year-old male with no known coronary artery disease (CAD) undergoing exercise stress. In comparison, an 80-year-old male with no known CAD undergoing adenosine stress would have significantly greater first- and second-year event rates. Of note, although the risk increases, the rates in the first and second years are not different. On the other hand, the counterparts of these two patients with CAD, as shown in the bottom two pairs of bars, would have significantly greater risk, the rate in the second year would exceed that in the first year, and the change in risk between year 1 and year 2 would increase as a function of age in the setting of known CAD. Black bars = year 2 predicted hard event rate. White bars = year 1 predicted hard event rate. Ad = adenosine; Ex = exercise; Hx = history; y.o. = year old.