Incremental prognostic value of rest-redistribution Tl-201 single-photon emission computed tomography

Background-The incremental prognostic value of rest-redistribution Tl-201 c ompared with stress and rest perfusion abnormalities has not been defined. Methods and Results-We identified 458 patients who underwent rest Tl-201/st ress (exercise or adenosine) Tc-99m sestamibi single-photon emission comput ed tomography (SPECT) and bad late (18 to 24 hours) Tl-201 imaging, were no t revascularized within 60 days of SPECT, and were followed up at >1 year. SPECT images were visually analyzed with the use of a 20-segment model on a scale of 0 to 4. Thirty-seven cardiac deaths (CDs) and 17 nonfatal myocard ial infarctions occurred. Univariate Cox proportional hazards analysis show ed that the presence of a large amount of rest Tl-201 reversibility (rest-l ate summed difference score [SDS] of >8) was a significant predictor of CD (chi(2) = 5.77, P = 0.02) and CD or myocardial infarction (chi(2) = 5.3, P = 0.02), The CD rate was 9.3% y(-1) in patients with rest-late SDS of >8 co mpared with 3.6% y(-1) in patients with a mild/moderate amount of rest reve rsibility (rest-late SDS 3 to 8) and 3.4% y(-1) in patients with no rest re versibility (rest-late SDS <3) (P = 0.029). Kaplan-Meier survival analysis demonstrated significantly lower cumulative survival rates in patients with rest-late SDS of >8 (P = 0.01). Multivariate Cox proportional hazards anal ysis demonstrated that the presence of a large amount of resting reversibil ity was an independent and incremental predictor of CD after adjustment for stress and rest perfusion information. Multivariate logistic regression an alysis demonstrated that resting reversibility was not an independent predi ctor of referral to coronary angiography and revascularization. Conclusions-The identification of a large amount of resting Tl-201 reversib ility is an independent predictor of CD over stress and rest perfusion abno rmalities.