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Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Prognostic significance of previous myocardial infarction and previous revascularization in patients undergoing SPECT
Robert J H Miller1, Eyal Klein2, Heidi Gransar2
1Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.
Insights
Prior myocardial infarction (MI) and revascularization without MI are equally significant predictors of mortality in patients undergoing SPECT MPI. This history is especially important for risk stratification in patients without ischemia.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Cardiovascular Imaging
Background:
- Accurate risk stratification is crucial for managing patients with known coronary artery disease (CAD).
- Prior myocardial infarction (MI) or revascularization without MI are often considered equivalent indicators of known CAD.
- The prognostic significance of prior MI versus revascularization without MI in patients undergoing SPECT MPI requires clarification.
Purpose of the Study:
- To compare the prognostic significance of prior MI and previous revascularization without MI in patients undergoing SPECT MPI.
- To assess the independent association of prior MI and revascularization with all-cause mortality.
- To determine if these factors have differential impacts on mortality, particularly in subgroups like patients without ischemia.
Main Methods:
- A cohort of 50,121 consecutive patients undergoing SPECT MPI between 1992 and 2012 was analyzed.
- Patient history, including prior MI and revascularization, was prospectively collected.
- Multivariable Cox regression analysis, adjusted for demographics, medical history, medications, and MPI results, was used to assess associations with all-cause mortality.
Main Results:
- Prior MI (14.8%) and revascularization without MI (7.2%) were independently associated with increased all-cause mortality (adjusted HR 1.12 and 1.15, respectively).
- Both prior MI and revascularization without MI were significant predictors of mortality, with no statistically significant difference in their associated risk.
- These CAD indicators were particularly significant for mortality risk in patients without inducible ischemia on SPECT MPI.
Conclusions:
- In patients undergoing SPECT MPI, both prior MI and prior revascularization without MI are independent predictors of all-cause mortality with similar risk.
- The history of CAD, whether prior MI or revascularization, is particularly valuable for risk stratification in patients without evidence of ischemia on MPI.
- These findings underscore the importance of considering specific CAD history when assessing prognosis in patients undergoing myocardial perfusion imaging.
Background:
Accurate risk stratification in patients with known coronary artery disease (CAD) is critical for patient management. Prior myocardial infarction (MI) or revascularization without MI are often equated as known CAD. We compared the prognostic significance of prior MI and previous revascularization in patients undergoing single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).
Methods:
Consecutive patients undergoing SPECT MPI at Cedars-Sinai Medical Center between 1992 and 2012 were included. Medical history, including history of MI or revascularization, was collected prospectively. Association with all-cause mortality was assessed with multivariable Cox analysis, adjusted for patient demographics, medical history, medications, and SPECT MPI results.
Results:
In total, 50,121 patients were identified including 7428 (14.8%) with a history of previous MI and 3608 (7.2%) with a history of revascularization without prior MI. During a median follow-up of 8.0 years, 19,696 (39.3%) patients died including 4467 (60.1%) with a history of MI and 1880 (52.1%) with a history of revascularization. Prior MI (adjusted HR 1.12, p=0.001) and prior revascularization without MI (adjusted HR 1.15, p<0.001) were independently associated with increased all-cause mortality. Previous MI (adjusted HR 1.27, p<0.001) and previous revascularization without MI (adjusted HR 1.21, p<0.001) were significantly associated with increased all-cause mortality only in patients without ischemia.
Conclusions:
In this large cohort of patients undergoing SPECT MPI, previous MI and previous revascularization without MI were independent predictors of all-cause mortality, with no significant difference in associated risk. History of CAD may be particularly important for risk stratification in patients without ischemia.
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