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A prognostic score for prediction of cardiac mortality risk after adenosine stress myocardial perfusion scintigraphy

Rory Hachamovitch, MD, MSc, FACC^*, Sean W. Hayes, MD, John D. Friedman, MD, FACC, Ishac Cohen, PhD and Daniel S. Berman, MD, FACC^,*

^* Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California
Department of Imaging (Division of Nuclear Medicine), Department of Medicine (Division of Cardiology), the CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, and Department of Medicine, University of California at Los Angeles, School of Medicine, Los Angeles, California

View larger version (36K): [in a new window]   Figure 1 Flow chart defining the number of patients included/excluded for various criteria and the definition of cohorts for the primary and secondary analyses.

View larger version (17K): [in a new window]   Figure 2 Rates of cardiac death (expressed per year of follow-up) in quartiles of prognostic score (p < 0.001 for all three groups across quartiles). Solid bars = training set; open bars = validation set; cross-hatched bars = overall set with recalculated scores.

View larger version (11K): [in a new window]   Figure 3 Kaplan-Meier two-year survival as a function of prognostic score in the overall population (p < 0.0001 [log-rank] across scores). Bars = 95% confidence intervals. These bars are centered at the mean prognostic score values of seven subgroups (mean value and number of patients): 1) 34.4, n = 387; 2) 42.3, n = 710; 3) 49.1, n = 1,528; 4) 55.3, n = 909; 5) 60.2, n = 601; 6) 65.9, n = 458; and 7) 74.9, n = 163.

View larger version (27K): [in a new window]   Figure 4 Rates of cardiac death (expressed per year of follow-up) in patients with low (<49), intermediate (49 to 57), and high (>57) prognostic scores (*p < 0.001 across three prognostic score categories). Solid bars = training set; open bars = validation set; cross-hatched bars = overall set with recalculated scores.

View larger version (11K): [in a new window]   Figure 5 Kaplan-Meier two-year survival as a function of the simplified prognostic score in the population examined (p < 0.0001 [log-rank] across scores). These bars are centered at the mean prognostic score values of five subgroups (mean value and number of patients): 1) 46.5, n = 408; 2) 67.3, n = 506; 3) 82.9, n = 807; 4) 97.4, n = 1,161; and 5) 123.9, n = 1,902.

View larger version (12K): [in a new window]   Figure 6 Kaplan-Meier two-year survival as a function of prognostic score in the population examined during the time period that walking adenosine stress was performed (p < 0.0001 [log-rank] across scores). Bars represent 95% confidence intervals. These bars are centered at the mean prognostic score values of seven subgroups (mean value and number of patients): 1) 30.5, n = 445; 2) 39.8, n = 620; 3) 45.6, n = 551; 4) 50.5, n = 556; 5) 57.2, n = 792; 6) 65.6, n = 218; and 7) 73.5, n = 112.