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Original Articles

Single-Photon Emission Computed Tomography Myocardial Perfusion Defects Are Associated With an Increased Risk of All-Cause Death, Cardiovascular Death, and Sudden Cardiac Death

Jonathan P. Piccini, MD; John R. Horton, MS; Linda K. Shaw, MS; Sana M. Al-Khatib, MD, MHS; Kerry L. Lee, PhD; Ami E. Iskandrian, MD and Salvador Borges-Neto, MD

From the Division of Cardiology, Department of Medicine, Duke University Medical Center (J.P.P., S.M.A.-K., S.B.-N.) and the Duke Clinical Research Institute (J.P.P., J.R.H., L.K.S., S.M.A.-K., K.L.L., S.B.-N.), Durham, NC; and Division of Cardiovascular Diseases, Department of Medicine (A.E.I.), University of Alabama at Birmingham.

Correspondence to Salvador Borges-Neto, MD, Nuclear Cardiology and Cardiac PET/CT, Duke University Medical Center, PO Box 3949, Durham, NC 27710. E-mail borge001{at}mc.duke.edu

Received February 28, 2008; accepted August 29, 2008.

Background— Single-photon emission computed tomography myocardial perfusion imaging defects are associated with increased all-cause mortality and cardiovascular death. However, it is unknown whether single-photon emission computed tomography myocardial perfusion imaging can identify patients at increased risk of sudden cardiac death (SCD).

Methods and Results— We analyzed a cohort of 6383 patients with angiographically documented coronary artery disease who underwent single-photon emission computed tomography imaging. Cox proportional hazards modeling was used to examine the relationship between patient characteristics and SCD. Among patients who died, the median time to SCD was 2.7 years (25^th, 75^th percentiles 0.9, 4.9, respectively). The incidence of SCD was 3.4% (n=215) over 6.1 years (25^th, 75^th percentiles 3.7, 9.2, respectively) of follow-up. Patients with SCD had more severe heart failure symptoms, greater comorbidity (Charlson index), and higher summed stress perfusion scores (all P<0.001). After adjusting for left ventricular ejection fraction and other clinical factors in the multivariable model, the summed stress perfusion score (fixed plus reversible defects) remained significantly associated with the occurrence of SCD: summed stress perfusion score (hazard ratios per 3 U: 1.16 [95% CI, 1.08 to 1.25], P<0.001), left ventricular ejection fraction (hazard ratios per 5 U: 0.90 [95% CI, 0.85 to 0.95], P<0.001), and Charlson index (hazard ratios 1.35 [95% CI, 1.23 to 1.49], P<0.001).

Conclusions— Myocardial perfusion imaging is a significant predictor of SCD and provides information independent of clinical history and left ventricular ejection fraction. Gated single-photon emission computed tomography imaging, which evaluates both myocardial perfusion and function, may represent a more effective means of risk stratification than solitary left ventricular ejection fraction determination and should be evaluated in prospective trials.

Key Words: sudden cardiac death • single-photon emission computed tomography • coronary artery disease • risk stratification

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CLINICAL PERSPECTIVE

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