Author + information
- Rine Nakanishi,
- Sean W. Hayes,
- Piotr Slomka,
- Mathews Fish,
- Heidi Gransar,
- Reza Arsanjani,
- Aryeh Shalev,
- Yuan Xu,
- Louise Thomson,
- John D. Friedman,
- Guido Germano and
- Daniel Berman
While prognostically useful, negative stress myocardial perfusion imaging (MPS) can be seen in patients with high risk coronary artery disease (CAD) as defined by invasive coronary angiography (ICA). Predictors of false negative MPS in patients with high risk CAD have not been described.
We studied 580 consecutive patients (age 64±12 years, 49% men) with no known coronary disease who underwent stress MPS [exercise (41%) or vasodilator (59%)] <2 months before ICA and had summed stress score (SSS) <4. Clinical and stress variables included age, gender, number of risk factors, typical angina, stress type and abnormal ECG response. MPS variables included SSS and transient ischemic dilation (TID). High risk CAD was defined as 3 vessels with ≥70% stenosis, 2 vessels with ≥70% stenosis including proximal left anterior descending, or left main ≥50%. Multivariable logistic regression analysis was performed, and standardized coefficients were used to assess the relative strength of the predictors.
42 subjects (7.2%) had high risk CAD and variables associated in decreasing levels of contribution to the predictive model were SSS, age, male gender, typical angina, and TID (all p<0.05). Model ROC curve area was 0.82 [75-88%] and accuracy was 93%.
Clinical and MPS findings can predict high risk CAD in patients with normal MPS. Consideration of these factors, particularly the SSS even when <4, may improve the overall assessment of risk in patients undergoing stress MPS.
|Odds ratio||95% CI||P value|
|Age per 10 years||1.7||1.2–2.3||0.002|
|Number of risk factors||1.3||0.96–1.8||0.09|
|Stress type (Exercise)||1.4||0.6–3.1||0.43|
|Abnormal ECG response||2.0||0.8–5.0||0.16|
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Prognostic Implications in Nuclear Imaging
Abstract Category: 21. Imaging: Nuclear
Presentation Number: 1315-362
- 2013 American College of Cardiology Foundation