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Myocardial Perfusion Imaging and Revascularization Predict Long-term All-cause Mortality in Patients with Suspected
Jei-Yie Huang1, Chun-Kai Huang2, Chi-Lun Ko3
1Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan (J.Y.H., C.L.K., K.L.C.); College of Medicine, National Taiwan University, Taipei, Taiwan (J.Y.H., C.K.H., K.L.C., Y.W.W.); Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (J.Y.H., C.K.H., K.L.C.); Department of Nuclear Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin County, Taiwan (J.Y.H., C.L.K., Y.W.W.).
Insights
Myocardial perfusion imaging (MPI) effectively predicts long-term mortality risk in coronary artery disease (CAD) patients. Early coronary revascularization significantly reduces mortality risk, highlighting MPI
Area of Science:
- Cardiology
- Nuclear Cardiology
- Cardiovascular Imaging
Background:
- Prognostic implications of myocardial perfusion imaging (MPI) are crucial for managing coronary artery disease (CAD).
- Routine clinical assessment of MPI's long-term prognostic value is essential.
Purpose of the Study:
- To quantify the long-term prognostic value of MPI in patients with suspected or known CAD under routine clinical conditions.
- To assess the association between coronary revascularization and survival in this cohort.
Main Methods:
- Single-center retrospective cohort study of 2278 patients with suspected or known CAD.
- Kaplan-Meier analysis and multivariable Cox regression were used to evaluate all-cause mortality and cause-specific survival based on MPI findings.
- Follow-up duration was 8.17±2.17 years, assessing outcomes stratified by MPI results and revascularization status.
Main Results:
- MPI severity was significantly associated with all-cause mortality (log-rank p<0.001).
- Both resting and post-stress MPI independently predicted increased mortality risk (rest MPI: HR 1.25; stress MPI: HR 1.29).
- Coronary revascularization was associated with reduced mortality risk (HR 0.43, p<0.001).
Conclusions:
- Resting and post-stress MPI demonstrate significant long-term prognostic value for all-cause mortality.
- Coronary revascularization is independently associated with a reduced risk of mortality in patients undergoing MPI.
- MPI findings are valuable for guiding patient management and treatment decisions in CAD.
Rationale And Objectives:
The prognostic implications of myocardial perfusion imaging (MPI) are imperative to provide proper management of coronary artery disease (CAD). This study aimed to quantify the long-term prognostic value of MPI under routine clinical conditions.
Materials And Methods:
This single-center retrospective cohort study evaluated all-cause mortality and cause-specific survival according to MPI findings in patients with suspected or known CAD who underwent diagnostic evaluation or assessment of myocardial ischemia and viability in a tertiary referral cardiovascular center. A total of 2278 patients (mean age: 64.22±10.37 years; (39.2%) 893 women) were included. Kaplan-Meier analysis and Cox proportional hazards regression were used to assess outcomes and control for confounding, stratified by MPI findings. The association between coronary revascularization and survival was also assessed.
Results:
During 8.17±2.17 years follow-up, 22.7% died and 16.8% received coronary revascularization (89.3±33.8 days after the index MPI). MPI severity was significantly associated with all-cause mortality (log-rank p<0.001). In multivariable Cox regression adjusting for age, gender, hypertension, diabetes, hyperlipidemia, prior myocardial infarction, body mass index, and left ventricular ejection fraction, both resting and post-stress MPI were independently associated with increased mortality risk (rest MPI: HR 1.25, 95% confidence interval (CI) 1.11-1.41, p<0.001; stress MPI: HR 1.29, 95% CI 1.15-1.45, p<0.001). Coronary revascularization was significantly associated with reduced risk of mortality (HR 0.43, 95% CI 0.32-0.57, p<0.001, in rest MPI model). The prognostic value of MPI persisted over short-, medium-, and long-term follow-up.
Conclusion:
Both resting and post-stress myocardial perfusion had good long-term prognostic value for all-cause mortality. Coronary revascularization was independently associated with a reduced risk of mortality.
