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Incremental Value of Exercise ECG to Myocardial Perfusion Single-Photon Emission Computed Tomography for Prediction of Cardiac Events

Kraen, Morten LU ; Akil, Shahnaz LU ; Hedén, Bo LU ; Berg, Jonathan LU orcid ; Ostenfeld, Ellen LU orcid ; Carlsson, Marcus LU ; Arheden, Håkan LU and Engblom, Henrik LU (2023) In Journal of the American Heart Association 12(9).
Abstract

BACKGROUND: Both myocardial perfusion single-photon emission computed tomography (MPS) and exercise ECG (Ex-ECG) carry prognostic information in patients with stable chest pain. However, it is not fully understood if combining the findings of MPS and Ex-ECG improves risk prediction. Current guidelines no longer recommend Ex-ECG for diagnostic evaluation of chronic coronary syndrome, but Ex-ECG could still be of incremental prognostic importance. METHODS AND RESULTS: This study comprised 908 consecutive patients (age 63.3±9.4 years, 49% male) who performed MPS with Ex-ECG. Subjects were followed for 5 years. The end point was a composite of cardiovascular death, acute myocardial infarction, unstable angina, and unplanned percutaneous... (More)

BACKGROUND: Both myocardial perfusion single-photon emission computed tomography (MPS) and exercise ECG (Ex-ECG) carry prognostic information in patients with stable chest pain. However, it is not fully understood if combining the findings of MPS and Ex-ECG improves risk prediction. Current guidelines no longer recommend Ex-ECG for diagnostic evaluation of chronic coronary syndrome, but Ex-ECG could still be of incremental prognostic importance. METHODS AND RESULTS: This study comprised 908 consecutive patients (age 63.3±9.4 years, 49% male) who performed MPS with Ex-ECG. Subjects were followed for 5 years. The end point was a composite of cardiovascular death, acute myocardial infarction, unstable angina, and unplanned percutaneous coronary intervention. National registry data and medical charts were used for end point allocation. Combining the findings of MPS and Ex-ECG resulted in concordant evidence of ischemia in 72 patients or absence of ischemia in 634 patients. Discordant results were found in 202 patients (MPS−/Ex-ECG+, n=126 and MPS+/Ex-ECG−, n=76). During follow-up, 95 events occurred. Annualized event rates significantly increased across groups (MPS−/Ex-ECG− =1.3%, MPS−/Ex-ECG+ =3.0%, MPS+/Ex-ECG− =5.1% and MPS+/Ex-ECG+ =8.0%). In multivariable analy-ses MPS was the strongest predictor regardless of Ex-ECG findings (MPS+/Ex-ECG−, hazard ratio [HR], 3.0, P=0.001 or MPS+/Ex-ECG+, HR,4.0, P<0.001). However, an abnormal Ex-ECG almost doubled the risk in subjects with normal MPS (MPS−/Ex-ECG+, HR, 1.9, P=0.04). CONCLUSIONS: In patients with chronic coronary syndrome, combining the results from MPS and Ex-ECG led to improved risk prediction. Even though MPS is the stronger predictor, there is an incremental value of adding data from Ex-ECG to MPS, especially in patients with normal MPS.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
exercise ECG, MPI, MPS, myocardial perfusion SPECT, prognosis, SPECT
in
Journal of the American Heart Association
volume
12
issue
9
article number
e028313
publisher
Wiley-Blackwell
external identifiers
  • pmid:37119075
  • scopus:85159403097
ISSN
2047-9980
DOI
10.1161/JAHA.122.028313
language
English
LU publication?
yes
additional info
Funding Information: This study was supported by the Swedish Heart and Lund Foundation, Region of Scania, and Lund University, Medical Faculty. Publisher Copyright: © 2023 The Authors.
id
35943fde-4a88-48a6-8d82-26b4c3160fcf
date added to LUP
2024-01-15 09:19:38
date last changed
2024-04-15 20:23:11
@article{35943fde-4a88-48a6-8d82-26b4c3160fcf,
  abstract     = {{<p>BACKGROUND: Both myocardial perfusion single-photon emission computed tomography (MPS) and exercise ECG (Ex-ECG) carry prognostic information in patients with stable chest pain. However, it is not fully understood if combining the findings of MPS and Ex-ECG improves risk prediction. Current guidelines no longer recommend Ex-ECG for diagnostic evaluation of chronic coronary syndrome, but Ex-ECG could still be of incremental prognostic importance. METHODS AND RESULTS: This study comprised 908 consecutive patients (age 63.3±9.4 years, 49% male) who performed MPS with Ex-ECG. Subjects were followed for 5 years. The end point was a composite of cardiovascular death, acute myocardial infarction, unstable angina, and unplanned percutaneous coronary intervention. National registry data and medical charts were used for end point allocation. Combining the findings of MPS and Ex-ECG resulted in concordant evidence of ischemia in 72 patients or absence of ischemia in 634 patients. Discordant results were found in 202 patients (MPS−/Ex-ECG+, n=126 and MPS+/Ex-ECG−, n=76). During follow-up, 95 events occurred. Annualized event rates significantly increased across groups (MPS−/Ex-ECG− =1.3%, MPS−/Ex-ECG+ =3.0%, MPS+/Ex-ECG− =5.1% and MPS+/Ex-ECG+ =8.0%). In multivariable analy-ses MPS was the strongest predictor regardless of Ex-ECG findings (MPS+/Ex-ECG−, hazard ratio [HR], 3.0, P=0.001 or MPS+/Ex-ECG+, HR,4.0, P&lt;0.001). However, an abnormal Ex-ECG almost doubled the risk in subjects with normal MPS (MPS−/Ex-ECG+, HR, 1.9, P=0.04). CONCLUSIONS: In patients with chronic coronary syndrome, combining the results from MPS and Ex-ECG led to improved risk prediction. Even though MPS is the stronger predictor, there is an incremental value of adding data from Ex-ECG to MPS, especially in patients with normal MPS.</p>}},
  author       = {{Kraen, Morten and Akil, Shahnaz and Hedén, Bo and Berg, Jonathan and Ostenfeld, Ellen and Carlsson, Marcus and Arheden, Håkan and Engblom, Henrik}},
  issn         = {{2047-9980}},
  keywords     = {{exercise ECG; MPI; MPS; myocardial perfusion SPECT; prognosis; SPECT}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{9}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{Incremental Value of Exercise ECG to Myocardial Perfusion Single-Photon Emission Computed Tomography for Prediction of Cardiac Events}},
  url          = {{http://dx.doi.org/10.1161/JAHA.122.028313}},
  doi          = {{10.1161/JAHA.122.028313}},
  volume       = {{12}},
  year         = {{2023}},
}