Technetium99m sestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting: The Nuclear Utility in the Community (NUC) Study

Gregory S. Thomas, Michael I. Miyamoto, A. Peter Morello, Haresh Majmundar, Jennifer J. Thomas, Christine H. Sampson, Rory Hachamovitch, Leslee J. Shaw

Research output: Contribution to journalArticlepeer-review

109 Scopus citations

Abstract

OBJECTIVES: The purpose of this study was to evaluate the prognostic value of community-based myocardial perfusion imaging (MPI) and to assess the incremental value of individual components of 99mTc-sestamibi single photon emission computed tomography (SPECT). BACKGROUND: Although the most rapid growth of MPI has been in community outpatient laboratories, its prognostic value has not been validated in this setting. METHODS: We prospectively followed 1,612 consecutive patients undergoing stress 99mTc-sestamibi SPECT in an outpatient community laboratory who experienced 71 hard events over 24 ± 7 months (0.2% lost to follow-up). RESULTS: Patients whose scans were normal incurred an annualized event rate of 0.4%, compared with 2.3% for those with abnormal scans (p < 0.0001). Subset analysis demonstrated comparable risk stratification for women and men, diabetics, patients with normal resting ECGs, and those referred for pharmacologic and exercise stress. After adjusting for pre-test variables, multivariable Cox regression analysis found the most potent independent components of MPI to be, in order of importance, transient ischemic dilation, extent of reversibility, post-stress ejection fraction, extent and severity of the stress perfusion defect, and the overall test result (normal or abnormal). Each 1% decrement of ejection fraction predicted a 3% increase in risk (p = 0.0009). Post-MPI angiography and revascularization increased commensurate with the extent and severity of MPI result. CONCLUSIONS: The prognostic value of perfusion imaging is portable and transferable to the outpatient community setting, with multiple components of MPI providing incremental prognostic information.

Original languageEnglish
Pages (from-to)213-223
Number of pages11
JournalJournal of the American College of Cardiology
Volume43
Issue number2
DOIs
StatePublished - 21 Jan 2004
Externally publishedYes

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