Prognostic value of myocardial perfusion SPECT images in combination with the maximal heart rate at exercise testing in Japanese patients with suspected ischemic heart disease: A sub-analysis of J-ACCESS

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• Objectives We assessed whether a combination of summed stress scores (SSS) using exercise myocardial perfusion SPECT (Ex-SPECT) and maximal heart rate accurately predicts cardiac events through a sub-analysis of J-ACCESS (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT) which was conducted to evaluate the prognosis of Japanese patients with suspected ischemic heart disease. Methods In J-ACCESS, 2,373 patients with suspected coronary artery disease not receiving beta-blocker treatment underwent Ex-SPECT. These patients were categorized into the following four groups: Group A [achieved target heart rate (THR) and SSS < 4: n = 631], B (did not achieve THR and SSS < 4: n = 612), C (achieved THR and SSS ≥ 4: n = 570), and D (did not achieve THR and SSS ≥ 4: n = 560). We evaluated the incidence rate of cardiac events including cardiac death, myocardial infarction, and heart failure requiring hospital admission during a 3-year period. Results In Group A, B, C, and D, 9 of 631 (1.4%), 15 of 612 (2.4%), 23 of 570 (4.0%) and 30 of 560 (5.4%) patients experienced cardiac events, respectively. Although the hazard ratio of the SSS ≥ 4 was 2.45 (p < 0.001) and that of the attained THR was 0.69 (p = 0.10) in the multiple Cox regression analysis, Kaplan–Meier curves showed that the cardiac events rate was lower in the order of A, B, C, and D (p < 0.001). Conclusion The combination of SSS using Ex-SPECT and the maximal heart rate is a useful predictor of cardiac events in patients with suspected coronary artery disease.

• 2009-12-01

著者

• YAMASHINA Akira

  Second Department of Internal Medicine, Tokyo Medical University

• NAKAO Kazuwa

  Kyoto University

• NAKAO Kazuwa

  Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine

• UESHIMA Kenji

  EBM Research Center, Kyoto University Graduate School of Medicine

• YASUNO Shinji

  EBM Research Center, Kyoto University Graduate School of Medicine

• Usami Satoru

  Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine

• Saito Yoshihiko

  熊本大学 医学教育部循環器病態学

• Saitou Yoshihiko

  奈良県立医科大学 総合医療学

• NISHIMURA Tsunehiko

  Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicin

• Yamashina Akira

  Second Department Of Internal Medicine Tokyo Medical University

• Yamashina Akira

  京都大学ebm研究センター

• Nakao K

  Kyoto University

• Nakao Kazuwa

  大阪府立病院機構大阪府立急性期総合医療センター

• Nakao Kazuwa

  Department Of Medicine And Clinical Science Kyoto University Graduate School Of Medicine

• Nakao Kazuwa

  国立病院機構京都医療センター 代謝臨床研究センター内分泌研究部

• Nakao K

  Department Of Medicine And Medical Science Kyoto University Graduate School Of Medicine

• Nishimura Tsunehiko

  Department Of Radiology Graduate School Of Medical Science Kyoto Prefectural University Of Medicine

• Nakao Kazuwa

  奈良県立医科大学 内科学第一

• Nakao Kazuwa

  Division Of Endocrinology And Metabolism Department Of Medicine And Clinical Science Kyoto Universit

• Ueshima Kenji

  Ebm Research Center Kyoto University Graduate School Of Medicine

• Kato Norihiro

  Department Of Gene Diagnostics And Therapeutics Research Institute International Medical Center Of J

• UESHIMA Kenji

  Kyoto University Graduate School of Medicine

• YASUNO Shinji

  Kyoto University Graduate School of Medicine

• NISHIYAMA Osamu

  Second Department of Internal Medicine, Iwate Medical University

• YAMAZAKI Takuya

  Second Department of Internal Medicine, Iwate Medical University

• Usami Satoru

  Department Of Medicine And Clinical Science Kyoto University Graduate School Of Medicine

• Nishimura Tsunehiko

  東京医科大学 循環器内科

• NAKAMURA Kenjiro

  Tenjin Sogo Clinic

• Nakao Kazuwa

  Department Of Endocrinology And Metabolism Kyoto University Graduate School Of Medicine

• Nakamura Kazuyo

  Department Of Preventive Medicine Faculty Of Medicine Saga University

• Yamazaki Takuya

  Second Department Of Internal Medicine Iwate Medical University

• Nishiyama Osamu

  Second Department Of Internal Medicine Iwate Medical University

• Yasuno Shinji

  Ebm Research Center Kyoto University Graduate School Of Medicine

• Sugio Y

  Kyushu Univ. Fukuoka Jpn

• Sudo Yoshikazu

  The Second Department Of Medicine Kyoto Prefectural University Of Medicine

• Saito Yoshihiko

  Ebm Research Center Kyoto University Graduate School Of Medicine

• Nakao Kazuwa

  The Department Of Medicine And Clinical Science

• Nishio Kazuko

  Department Of Preventive Medicine-biostatistics And Medical Decision Making Nagoya University Gradua

• Nagatsuka Kazuyuki

  Department Of Medicine And Clinical Science Kyoto University Graduate School Of Medicine

• Nakao Kazuwa

  Department Of Endcrinology And Metabolism Kyoto University Graduate School Of Medicine

• Kato Norihiro

  Department Of Gene Diagnostics And Therapeutics Research Institute International Medical Center Of J

• Kato Norihiro

  Graduate School Of Human And Environmental Studies University Of Kyoto

• Nagatsuka Kazuyuki

  Department Of Medicine And Clinical Sciences Graduate School Of Medicine Kyoto University

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