Published Online
on September 17, 2008

A more recent version of this article appeared on November 1, 2008

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Original Article

SPECT Myocardial Perfusion Defects Are Associated with an Increased Risk of All-Cause Death, Cardiovascular Death and Sudden Cardiac Death

Jonathan P Piccini¹; John R Horton¹; Linda K Shaw¹; Sana M Al-Khatib¹; Kerry L Lee¹; Ami E Iskandrian² and Salvador Borges-Neto^1,3

¹ Duke Clinical Research Institute, Durham, NC;
² University of Alabama at Birmingham, Birmingham, AL

³ E-mail: borge001{at}mc.duke.edu

Background—SPECT myocardial perfusion imaging (MPI) defects are associated with increased all-cause mortality and cardiovascular death. However, it is unknown if SPECT MPI can identify patients at increased risk of sudden cardiac death (SCD).

Methods and Results—We analyzed a cohort of 6,383 patients with angiographically documented coronary artery disease (CAD) who underwent SPECT 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 (25th, 75th percentiles 0.9, 4.9). The incidence of SCD was 3.4% (n=215) over 6.1 years (25th, 75th percentiles 3.7, 9.2) of follow-up. Patients with SCD had more severe heart failure symptoms, greater co-morbidity (Charlson index) and higher summed stress perfusion scores (SSS) (all p<0.001). After adjusting for LVEF and other clinical factors in the multivariable model, the SSS score (fixed plus reversible defects) remained significantly associated with the occurrence of SCD: SSS (HR per 3 units: 1.16 [95% 1.08-1.25], p<0.001), LVEF (HR per 5 units: 0.90 [95%CI 0.85-0.95], p<0.001), and Charlson index (HR 1.35 [95%CI 1.23-1.49], p<0.001).

Conclusions—Myocardial perfusion imaging is a significant predictor of SCD and provides information independent of clinical history and LVEF. Gated SPECT imaging, which evaluates both myocardial perfusion and function, may represent a more effective means of risk stratification than solitary LVEF determination and should be evaluated in prospective trials.

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

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