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515 Early and late cardiovascular outcomes of pharmacologic stress myocardial perfusion imaging (MPI)
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Abstracts
clinical and investigational results at each visit. The CHFN database was analyzed in all patients who had documented entry visits as well as last clinic visit or death. Baseline univariate characteristics at baseline were identified that were associated with mortality during long term followup (all at a significance level of P ⬍ 0.001). RESULTS: Increased mortality was associated with: diabetes treated with insulin (OR 1.74 vs no diabetes). NYHA class (class II, OR 1.7; class III, OR 3.66; class IV, 7.21 vs NYHA class I); larger LV end diastolic dimension (OR 1.10); HF duration (OR 1.04). Improved survival was associated with: higher total cholesterol (OR 0.84); history of hypertension (OR 0.88); higher BMI (OR 0.95); diastolic BP (OR 0.97); systolic BP (OR 0.99); LVEF (OR 0.99). CONCLUSION: In this large contemporary population of outpatient heart failure patients followed in specialized multidisciplinary outpatient clinics, the baseline characteristics identified may help to identify those at greatest risk. Increased surveillance and interventions may help to improve clinical outcomes.
559) with multivariable-adjusted hazard ratios (HRs) shown (Table). Distribution of SSS was as follows: 0 (n ⫽ 2620), 1-3 (n ⫽ 1267), 4-6 (n ⫽ 888), or ⱖ 7 (n ⫽ 1465). Multivariable-adjusted HRs for MI or death for SSS 1-3, 4-6, and ⱖ7 were 1.22, 1.75, and 2.49 (P ⬍ 0.001), respectively. HRs for early MI or death for SSS 1-3, 4-6, and ⱖ 7 were 11.46 (P ⬍ 0.05), 17.24 (P ⬍ 0.01), and 16.63 (P ⬍ 0.01), respectively. HRs for MI, death or late revascularization were and 1.18 (P ⬍ 0.05), 1.19 (P ⬍ 0.05), and 1.71 (P ⬍ 0.001), respectively. While presence of TID, post-stress ESV, and post-stress LVEF were not significant predictors of MI or death, stress ST-shift was a significant predictor of early MI or death (HR 4.04; 95% CI; 1.48-11.04, P ⬍ 0.01). CONCLUSION: SSS and %LV ischemia were major predictors of a broad range of outcomes including early MI or death, and MI, death or late coronary revascularization procedures in extended follow-up.
Canadian Cardiovascular Society (CCS) CCS316 Oral STRESS IMAGING: DIAGNOSING DISEASE AND EVALUATING PROGNOSIS Tuesday, October 25, 2011 515 EARLY AND LATE CARDIOVASCULAR OUTCOMES OF PHARMACOLOGIC STRESS MYOCARDIAL PERFUSION IMAGING (MPI) DS Lee, X Wang, M Husain, F Verocai, RM Iwanochko Toronto, Ontario BACKGROUND: The prognostic impact of pharmacologic stress MPI
on a broad range of outcomes has not been fully explored. We examined consecutive patients who underwent pharmacologic stress MPI, and the occurrence of clinical outcomes including death, myocardial infarction (MI), and late coronary revascularization procedures. MI and revascularization procedures were identified by linkages with the Canadian Institute for Health Information database, and deaths via the Registered Persons Database. We examined the association of summed stress score (SSS) and %LV ischemia with MI or death censoring upon occurrence of coronary revascularization, adjusting for age, sex, stress ST-shift, presence of TID, post-stress end-systolic volume (ESV), and post-stress LV ejection fraction (LVEF). Early MI or death (events occurring within 90 days), and the composite outcome of death, MI, or late coronary revascularization procedures (⬎90 days post-MPI) was also examined. RESULTS: A total of 6240 patients (56% men; mean age 64.7 ⫾ 12.2 years) were followed for an average of 3.1 ⫾ 1.1 years, and a total of 19,382 person-years of follow-up were examined. During follow-up, there were 346 MIs (5.5%), 926 deaths (14.8%), and 642 (10.3%) underwent coronary artery revascularization. %LV ischemia was 0% (n ⫽ 3658), 1-4% (n ⫽ 1294), 5-9% (n ⫽ 729), or ⱖ10% (n ⫽ METHODS:
Student Presentation Award Finalist Clinical Science
516 CARDIAC FDG PET RESULTS IMPACT DECISIONS AND IDENTIFY PATIENTS LIKELY TO BENEFIT FROM REVASCULARIZATION IN A MULTI-CENTER PROVINCIAL REGISTRY (CADRE) AB Hall, MC Ziadi, A Guo, L Chen, RA deKemp, JM Renaud, J Etele, J Brennan, RA Davies, B Chow, TD Ruddy, R Hessian, M Iwanochko, G Wisenberg, K Gulenchyn, C Marriott, J DaSilva, EP Ficaro, L Garrard, RS Beanlands Ottawa, Ontario BACKGROUND: Better identification of individuals most likely to benefit from revascularization (revasc) could improve outcomes in pts with ischemic LV dysfunction. The PARR2 study & its post-hoc analyses showed that FDG PET-defined hibernating myocardium may be used to select such pts. Thus, a prospective provincial cardiac FDG PET registry was established in Ont. to determine the impact of FDG PET on ‘realworld’ decision making for revasc & if PET-defined hibernation predicts high risk pts. METHODS/RESULTS: 390 PET scans were performed between 2007-2010. Inclusion criteria: A-i) LVEF ⱕ 35%; A-ii) potential candidate for revasc or heart transplant; A-iii) NYHA or CCS class II-IV symptoms; or B) lack of viability or equivocal viability findings on other non-invasive testing. Of 390 pts; 31
Abstracts
clinical and investigational results at each visit. The CHFN database was analyzed in all patients who had documented entry visits as well as last clinic visit or death. Baseline univariate characteristics at baseline were identified that were associated with mortality during long term followup (all at a significance level of P ⬍ 0.001). RESULTS: Increased mortality was associated with: diabetes treated with insulin (OR 1.74 vs no diabetes). NYHA class (class II, OR 1.7; class III, OR 3.66; class IV, 7.21 vs NYHA class I); larger LV end diastolic dimension (OR 1.10); HF duration (OR 1.04). Improved survival was associated with: higher total cholesterol (OR 0.84); history of hypertension (OR 0.88); higher BMI (OR 0.95); diastolic BP (OR 0.97); systolic BP (OR 0.99); LVEF (OR 0.99). CONCLUSION: In this large contemporary population of outpatient heart failure patients followed in specialized multidisciplinary outpatient clinics, the baseline characteristics identified may help to identify those at greatest risk. Increased surveillance and interventions may help to improve clinical outcomes.
559) with multivariable-adjusted hazard ratios (HRs) shown (Table). Distribution of SSS was as follows: 0 (n ⫽ 2620), 1-3 (n ⫽ 1267), 4-6 (n ⫽ 888), or ⱖ 7 (n ⫽ 1465). Multivariable-adjusted HRs for MI or death for SSS 1-3, 4-6, and ⱖ7 were 1.22, 1.75, and 2.49 (P ⬍ 0.001), respectively. HRs for early MI or death for SSS 1-3, 4-6, and ⱖ 7 were 11.46 (P ⬍ 0.05), 17.24 (P ⬍ 0.01), and 16.63 (P ⬍ 0.01), respectively. HRs for MI, death or late revascularization were and 1.18 (P ⬍ 0.05), 1.19 (P ⬍ 0.05), and 1.71 (P ⬍ 0.001), respectively. While presence of TID, post-stress ESV, and post-stress LVEF were not significant predictors of MI or death, stress ST-shift was a significant predictor of early MI or death (HR 4.04; 95% CI; 1.48-11.04, P ⬍ 0.01). CONCLUSION: SSS and %LV ischemia were major predictors of a broad range of outcomes including early MI or death, and MI, death or late coronary revascularization procedures in extended follow-up.
Canadian Cardiovascular Society (CCS) CCS316 Oral STRESS IMAGING: DIAGNOSING DISEASE AND EVALUATING PROGNOSIS Tuesday, October 25, 2011 515 EARLY AND LATE CARDIOVASCULAR OUTCOMES OF PHARMACOLOGIC STRESS MYOCARDIAL PERFUSION IMAGING (MPI) DS Lee, X Wang, M Husain, F Verocai, RM Iwanochko Toronto, Ontario BACKGROUND: The prognostic impact of pharmacologic stress MPI
on a broad range of outcomes has not been fully explored. We examined consecutive patients who underwent pharmacologic stress MPI, and the occurrence of clinical outcomes including death, myocardial infarction (MI), and late coronary revascularization procedures. MI and revascularization procedures were identified by linkages with the Canadian Institute for Health Information database, and deaths via the Registered Persons Database. We examined the association of summed stress score (SSS) and %LV ischemia with MI or death censoring upon occurrence of coronary revascularization, adjusting for age, sex, stress ST-shift, presence of TID, post-stress end-systolic volume (ESV), and post-stress LV ejection fraction (LVEF). Early MI or death (events occurring within 90 days), and the composite outcome of death, MI, or late coronary revascularization procedures (⬎90 days post-MPI) was also examined. RESULTS: A total of 6240 patients (56% men; mean age 64.7 ⫾ 12.2 years) were followed for an average of 3.1 ⫾ 1.1 years, and a total of 19,382 person-years of follow-up were examined. During follow-up, there were 346 MIs (5.5%), 926 deaths (14.8%), and 642 (10.3%) underwent coronary artery revascularization. %LV ischemia was 0% (n ⫽ 3658), 1-4% (n ⫽ 1294), 5-9% (n ⫽ 729), or ⱖ10% (n ⫽ METHODS:
Student Presentation Award Finalist Clinical Science
516 CARDIAC FDG PET RESULTS IMPACT DECISIONS AND IDENTIFY PATIENTS LIKELY TO BENEFIT FROM REVASCULARIZATION IN A MULTI-CENTER PROVINCIAL REGISTRY (CADRE) AB Hall, MC Ziadi, A Guo, L Chen, RA deKemp, JM Renaud, J Etele, J Brennan, RA Davies, B Chow, TD Ruddy, R Hessian, M Iwanochko, G Wisenberg, K Gulenchyn, C Marriott, J DaSilva, EP Ficaro, L Garrard, RS Beanlands Ottawa, Ontario BACKGROUND: Better identification of individuals most likely to benefit from revascularization (revasc) could improve outcomes in pts with ischemic LV dysfunction. The PARR2 study & its post-hoc analyses showed that FDG PET-defined hibernating myocardium may be used to select such pts. Thus, a prospective provincial cardiac FDG PET registry was established in Ont. to determine the impact of FDG PET on ‘realworld’ decision making for revasc & if PET-defined hibernation predicts high risk pts. METHODS/RESULTS: 390 PET scans were performed between 2007-2010. Inclusion criteria: A-i) LVEF ⱕ 35%; A-ii) potential candidate for revasc or heart transplant; A-iii) NYHA or CCS class II-IV symptoms; or B) lack of viability or equivocal viability findings on other non-invasive testing. Of 390 pts; 31