Abstract:
OBJECTIVES:We sought to determine the relative influence of estimated functional capacity and thallium-201 (Tl-201) single-photon emission computed tomographic (SPECT) findings on prediction of short-term all-cause and cardiac-related mortality. BACKGROUND:Decreased functional capacity and abnormal Tl-201 SPECT findings are predictive of increased cardiovascular risk and mortality. However, the relative importance of these variables as predictors of all-cause mortality is not well established. METHODS:Analyses were based on 3,400 consecutive adults undergoing symptom-limited exercise Tl-201 SPECT testing at the Cleveland Clinic Foundation between September 1990 and December 1993; none had previous invasive procedures, heart failure or valve disease. Estimated functional capacity, classified by age and gender, and thallium perfusion defects, expressed as a stress extent thallium score on a 12-segment scale, were analyzed to determine their relative prognostic importance during 2 years of follow-up. RESULTS:Of 3,400 patients, 108 (3.2%) died during follow-up; 32 deaths were identified as cardiac related. On univariable analysis, estimated functional capacity was a strong predictor of death, with 62 (57%) deaths occurring in patients achieving < 6 metabolic equivalents (METs) (log-rank chi-square 86, p < 0.0001). On multivariable analysis, the strongest independent predictors of all-cause mortality were fair or poor functional capacity (adjusted relative risk [RR] 3.96, 95% confidence interval [CI] 2.36 to 6.64, chi-square 27, p < 0.0001) and age (adjusted RR for 10 years 2.25, 95% CI 1.80 to 2.80, chi-square 27, p < 0.0001). The presence of SPECT thallium perfusion defects was a less powerful predictor of death (for each two additional segments with defects, adjusted RR 1.21, 95% CI 1.03 to 1.43, chi-square 5, p = 0.02). Cardiac mortality was predicted by both fair or poor functional capacity (adjusted RR 4.37, 95% CI 1.59 to 12.00, chi-square 8, p = 0.004) and by stress extent thallium score (adjusted RR 1.62, 95% CI 1.25 to 2.11, chi-square 13, p = 0.0003). CONCLUSIONS:In this clinically low risk group, estimated functional capacity was a strong and overwhelmingly important independent predictor of all-cause mortality among patients undergoing exercise Tl-201 SPECT testing. The extent of myocardial perfusion defects was of comparable importance for the prediction of cardiac mortality.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Snader CE,Marwick TH,Pashkow FJ,Harvey SA,Thomas JD,Lauer MSdoi
10.1016/s0735-1097(97)00217-9subject
Has Abstractpub_date
1997-09-01 00:00:00pages
641-8issue
3eissn
0735-1097issn
1558-3597pii
S0735-1097(97)00217-9journal_volume
30pub_type
杂志文章abstract:OBJECTIVES:The study compared the adjusted risk for developing atrial fibrillation (AF) after minimally invasive direct coronary artery bypass surgery (MIDCAB) and coronary artery bypass graft surgery (CABG). BACKGROUND:Atrial fibrillation results in increased morbidity and delays hospital discharge after CABG. Recent...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)00974-8
更新日期:2000-11-15 00:00:00
abstract::This is a review of the important randomized trials of intracoronary and intravenous streptokinase therapy for treatment of acute myocardial infarction. Trials carried out before 1980 failed to recognize the relations between early coronary reperfusion and myocardial salvage and therefore have not been included in thi...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,评审
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更新日期:1987-11-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to assess the value of implantable cardioverter-defibrillator (ICD) electrograms (EGMs) in identifying clinically documented ventricular tachycardias (VTs). BACKGROUND:Twelve-lead electrocardiograms (ECG) of spontaneous VT often are not available in patients referred for cathet...
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更新日期:2010-09-14 00:00:00
abstract:OBJECTIVES:This study aimed to determine whether angiographically visualized collateral vessels in patients with chronic coronary artery disease imply the presence of viable myocardium in asynergic regions subtended by completely occluded coronary arteries. BACKGROUND:Patients with chronic coronary artery disease who ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(94)90630-0
更新日期:1994-03-15 00:00:00
abstract:OBJECTIVES:This study aimed to investigate the effect of both history of intermittent atrial tachyarrhythmias (IAT) and in-trial IAT on the risk of heart failure (HF) or death comparing cardiac resynchronization therapy with defibrillator (CRT-D) to implantable cardioverter-defibrillator (ICD) treatment in mildly sympt...
journal_title:Journal of the American College of Cardiology
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更新日期:2014-04-01 00:00:00
abstract::Development or progression of left ventricular hypertrophy has recently been described in children with hypertrophic cardiomyopathy. To determine whether similar changes in magnitude and distribution of left ventricular hypertrophy may also occur in adult patients with this disease, serial assessment of left ventricul...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(87)80301-7
更新日期:1987-05-01 00:00:00
abstract:OBJECTIVES:We examined whether unloading of the left ventricle with a ventricular assist device (LVAD) can result in normalization of the creatine kinase (CK) abnormalities in the failing human heart. BACKGROUND:Left ventricular failure is associated with a decrease of myocardial total CK activity and a fetal shift in...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(02)01860-0
更新日期:2002-06-05 00:00:00
abstract:OBJECTIVES:The aim of the present study was to examine the relation between the plasma levels of the atrial peptide N-terminal proatrial natriuretic factor (proANF) measured during the 1st 12 h after myocardial infarction and 1-year mortality. BACKGROUND:The atrial peptides atrial natriuretic factor and N-terminal pro...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(95)00342-8
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更新日期:1993-02-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究
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更新日期:1991-12-01 00:00:00
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更新日期:2015-09-08 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
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更新日期:2011-03-22 00:00:00
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pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2020-05-12 00:00:00
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doi:10.1016/j.jacc.2009.04.080
更新日期:2009-09-08 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0735-1097(93)90390-m
更新日期:1993-06-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(88)90462-7
更新日期:1988-10-01 00:00:00
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更新日期:1990-12-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(83)80031-x
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更新日期:2019-09-03 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:2004-09-15 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(92)90520-w
更新日期:1992-03-15 00:00:00
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journal_title:Journal of the American College of Cardiology
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doi:10.1016/s0735-1097(00)00600-8
更新日期:2000-05-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2009.09.061
更新日期:2010-03-09 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(10)80134-2
更新日期:1991-05-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/0735-1097(94)00367-y
更新日期:1995-02-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:2008-02-19 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.07.048
更新日期:2004-02-04 00:00:00
abstract:BACKGROUND:Patients with diabetes appear to be at elevated risk of atherothrombotic events. OBJECTIVES:The purpose of this study was to determine the effect of antiplatelet therapy with ticagrelor on recurrent ischemic events in patients with diabetes and prior myocardial infarction (MI). METHODS:We examined the subg...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jacc.2016.03.529
更新日期:2016-06-14 00:00:00