Cardiovascular events in Japan. Lessons from the J-ACCESS multicenter prognostic study using myocardial perfusion...

Area of Science:

• Cardiology
• Nuclear Medicine
• Medical Imaging

Background:

• The Japanese-Assessment of Cardiac Events and Survival Study (J-ACCESS) was the first study in Japan to quantify cardiac events and survival.
• It utilized stress-rest-gated single-photon emission computed tomography myocardial perfusion imaging (MPI) and quantitative gating software (QGS).

Purpose of the Study:

• To assess the prognostic value of MPI and left ventricular (LV) function for cardiac events in a large Japanese cohort.
• To evaluate the association of diabetes and chronic kidney disease (CKD) with cardiac events.
• To establish risk stratification and therapeutic guidance based on MPI findings.

Main Methods:

• A multicenter study involving 117 institutions and 4,629 patients.
• Analysis of stress-rest-gated SPECT MPI and QGS software for quantifying perfusion and LV function.
• 3-year follow-up to determine cardiac event incidence.

Main Results:

• A low incidence of hard cardiac events was observed compared to US and European studies.
• Normal MPI was associated with a low event risk.
• Large perfusion defects and LV dysfunction were significant predictors of major cardiac events.
• MPI demonstrated utility even in patients with known coronary artery stenosis.
• Diabetes and CKD were identified as important predictors of cardiac events.

Conclusions:

• MPI is a valuable tool for risk stratification in patients undergoing cardiac evaluation.
• Normal MPI reliably predicts a low risk of cardiac events.
• Patients with perfusion defects and LV dysfunction require intensified management.
• Further research (J-ACCESS 2 and 3) explored risks in asymptomatic diabetes and CKD.
• Risk estimation should inform therapeutic strategies within national healthcare systems.