Short- and long-term prognostic performance of exercise ECG and myocardial perfusion SPECT

Area of Science:

• Cardiology
• Diagnostic Imaging
• Preventive Medicine

Background:

• Myocardial perfusion SPECT (MPS) and exercise ECG (Ex-ECG) are vital for short-term prognosis.
• Their long-term predictive value is less clear, especially with increasing importance of ischemic heart disease (IHD) risk factors.

Purpose of the Study:

• To evaluate the short- and long-term prognostic capabilities of MPS and Ex-ECG.
• To assess these capabilities in relation to established risk factors for IHD.

Main Methods:

• An observational study included 908 patients referred for MPS and Ex-ECG.
• Follow-up was divided into short-term (<5 years) and long-term (>5 years).
• Cardiac events included myocardial infarction, unstable angina, unplanned revascularization, and cardiovascular death.

Main Results:

• MPS and Ex-ECG strongly predicted short-term cardiac events (p<0.001 and p=0.002, respectively).
• Neither test predicted long-term events (p=0.70 and p=0.92, respectively).
• Male sex and prior IHD were consistent predictors; age, diabetes, and exercise capacity predicted long-term outcomes.

Conclusions:

• The prognostic utility of MPS and Ex-ECG is significant for short-term risk stratification.
• Their predictive value wanes significantly after five years.
• Long-term cardiac prognosis is predominantly influenced by underlying risk factors and exercise capacity.