Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies

Azhar Supariwala, Seth Uretsky, Padmakshi Singh, Salim Memon, Surinder S. Khokhar, Omar Wever-Pinzon, Prashanth Atluri, Joseph Hersh, Hari K. Koppuravuri, Alan Rozanski

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)207-214
Number of pages8
JournalJournal of Nuclear Cardiology
Volume18
Issue number2
DOIs
StatePublished - Apr 1 2011
Externally publishedYes

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Single-Photon Emission-Computed Tomography
Coronary Artery Disease
Exercise
Survival
Mortality
Heart Diseases
Social Security
Population
Smoking
Hypertension

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Supariwala, Azhar ; Uretsky, Seth ; Singh, Padmakshi ; Memon, Salim ; Khokhar, Surinder S. ; Wever-Pinzon, Omar ; Atluri, Prashanth ; Hersh, Joseph ; Koppuravuri, Hari K. ; Rozanski, Alan. / Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies. In: Journal of Nuclear Cardiology. 2011 ; Vol. 18, No. 2. pp. 207-214.
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title = "Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies",
abstract = "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.",
author = "Azhar Supariwala and Seth Uretsky and Padmakshi Singh and Salim Memon and Khokhar, {Surinder S.} and Omar Wever-Pinzon and Prashanth Atluri and Joseph Hersh and Koppuravuri, {Hari K.} and Alan Rozanski",
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Supariwala, A, Uretsky, S, Singh, P, Memon, S, Khokhar, SS, Wever-Pinzon, O, Atluri, P, Hersh, J, Koppuravuri, HK & Rozanski, A 2011, 'Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies', Journal of Nuclear Cardiology, vol. 18, no. 2, pp. 207-214. https://doi.org/10.1007/s12350-010-9330-3

Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies. / Supariwala, Azhar; Uretsky, Seth; Singh, Padmakshi; Memon, Salim; Khokhar, Surinder S.; Wever-Pinzon, Omar; Atluri, Prashanth; Hersh, Joseph; Koppuravuri, Hari K.; Rozanski, Alan.

In: Journal of Nuclear Cardiology, Vol. 18, No. 2, 01.04.2011, p. 207-214.

Research output: Contribution to journalArticle

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T1 - Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies

AU - Supariwala, Azhar

AU - Uretsky, Seth

AU - Singh, Padmakshi

AU - Memon, Salim

AU - Khokhar, Surinder S.

AU - Wever-Pinzon, Omar

AU - Atluri, Prashanth

AU - Hersh, Joseph

AU - Koppuravuri, Hari K.

AU - Rozanski, Alan

PY - 2011/4/1

Y1 - 2011/4/1

N2 - 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.

AB - 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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