BACKGROUND: Normal exercise single-photon emission computed tomography (SPECT) studies are associated with a low event rate (<1.0%/year) during short-term follow-up. The influence of cardiac risk factors on long-term outcomes in such patients has not been well studied. MATERIAL AND METHODS: 2,597 patients (55 ± 12 years, male 41%) without a history of heart disease and a normal exercise SPECT between the years 1995 and 2006 were followed for a mean 6.8 ± 3.1 years for all-cause mortality assessed for using the Social Security Death Index. Baseline clinical risk factors and other clinical information were recorded for each patient and compared to outcomes. RESULTS: The mortality rate was 0.9%/year for our overall study population but varied according to individual baseline risk factors. Three coronary artery disease (CAD) risk factors were significant predictors of all-cause mortality: hypertension, diabetes, and smoking. When all three were absent, long-term all-cause mortality rate averaged 0.2%/year and when all three were present, all-cause mortality averaged 1.8%/year, constituting a 5.7-fold adjusted increase in risk (95% CI 2.7-12.8, P < .0001). CONCLUSIONS: During follow-up, annualized mortality rate varies markedly according to the number of CAD risk factors in patients without known heart disease and a normal exercise SPECT stress. Despite overall excellent long-term prognosis of a normal exercise SPECT, the burden of traditional CAD risk factors exert a strong synergistic influence on long-term survival and warrant aggressive treatment in this patient population.
BACKGROUND: Normal exercise single-photon emission computed tomography (SPECT) studies are associated with a low event rate (<1.0%/year) during short-term follow-up. The influence of cardiac risk factors on long-term outcomes in such patients has not been well studied. MATERIAL AND METHODS: 2,597 patients (55 ± 12 years, male 41%) without a history of heart disease and a normal exercise SPECT between the years 1995 and 2006 were followed for a mean 6.8 ± 3.1 years for all-cause mortality assessed for using the Social Security Death Index. Baseline clinical risk factors and other clinical information were recorded for each patient and compared to outcomes. RESULTS: The mortality rate was 0.9%/year for our overall study population but varied according to individual baseline risk factors. Three coronary artery disease (CAD) risk factors were significant predictors of all-cause mortality: hypertension, diabetes, and smoking. When all three were absent, long-term all-cause mortality rate averaged 0.2%/year and when all three were present, all-cause mortality averaged 1.8%/year, constituting a 5.7-fold adjusted increase in risk (95% CI 2.7-12.8, P < .0001). CONCLUSIONS: During follow-up, annualized mortality rate varies markedly according to the number of CAD risk factors in patients without known heart disease and a normal exercise SPECT stress. Despite overall excellent long-term prognosis of a normal exercise SPECT, the burden of traditional CAD risk factors exert a strong synergistic influence on long-term survival and warrant aggressive treatment in this patient population.
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Authors: Leslee J Shaw; Daniel S Berman; David J Maron; G B John Mancini; Sean W Hayes; Pamela M Hartigan; William S Weintraub; Robert A O'Rourke; Marcin Dada; John A Spertus; Bernard R Chaitman; John Friedman; Piotr Slomka; Gary V Heller; Guido Germano; Gilbert Gosselin; Peter Berger; William J Kostuk; Ronald G Schwartz; Merill Knudtson; Emir Veledar; Eric R Bates; Benjamin McCallister; Koon K Teo; William E Boden Journal: Circulation Date: 2008-02-11 Impact factor: 29.690
Authors: Jane A Simonsen; Oke Gerke; Charlotte K Rask; Mohammad Tamadoni; Anders Thomassen; Søren Hess; Allan Johansen; Hans Mickley; Lisette O Jensen; Jesper Hallas; Werner Vach; Poul F Høilund-Carlsen Journal: J Nucl Cardiol Date: 2013-03-01 Impact factor: 5.952
Authors: Ryo Nakazato; Daniel S Berman; Heidi Gransar; Mark Hyun; Romalisa Miranda-Peats; Faith C Kite; Sean W Hayes; Louise E J Thomson; John D Friedman; Alan Rozanski; Piotr J Slomka Journal: J Nucl Cardiol Date: 2012-10-12 Impact factor: 5.952
Authors: Alan Rozanski; Heidi Gransar; James K Min; Sean W Hayes; John D Friedman; Louise E J Thomson; Daniel S Berman Journal: J Nucl Cardiol Date: 2013-12-31 Impact factor: 5.952
Authors: Jane Angel Simonsen; Hans Mickley; Allan Johansen; Søren Hess; Anders Thomassen; Oke Gerke; Lisette O Jensen; Jesper Hallas; Werner Vach; Poul F Hoilund-Carlsen Journal: BMJ Open Date: 2017-08-11 Impact factor: 2.692