Introduction
Materials and Methods
Study Design and Participants
Protocol for MPI
Evaluation of MPI Findings
Follow-up
Statistical Analysis
Results
Characteristics of the Patients
Total | Cardiac events | |||
---|---|---|---|---|
N = 529 | Yes n = 60 | No n = 469 |
P
| |
Age (years) | 71.6 ± 10.9 (28–92) | 71.9 ± 12.7 (33–92) | 71.5 ± 10.6 (28–92) | .46 |
Male (%) | 67.3 | 65.0 | 67.6 | .80 |
BMI, (kg/m2) | 24.1 ± 4.1 (14.2–45.9) | 24.0 ± 5.0 (16.4–45.9) | 24.2 ± 4.0 (14.2–41.6) | .17 |
Smoking (%) | 6 | 12 | 6 | .14 |
Hypertension (%) | 91 | 90 | 91 | .94 |
Diabetes (%) | 42 | 47 | 41 | .48 |
Dyslipidemia (%) | 49 | 50 | 48 | .92 |
PAD (%) | 8 | 8 | 8 | 1.00 |
Cerebral infarction (%) | 9 | 7 | 9 | .69 |
Family history of juvenile CAD (%) | 1 | 2 | 1 | 1.00 |
Typical chest pain (%) | 34 | 35 | 34 | .98 |
Dyspnea or palpitation suggesting ischemia (%) | 46 | 43 | 46 | .75 |
ECG abnormalities (%) | 50 | 65 | 48 | .02 |
SSS | 1.9 ± 3.8 (0–29) | 3.6 ± 6.3 (0–25) | 1.6 ± 3.2 (0–29) | .16 |
SSS ≥4 (%) | 19 | 30 | 17 | .024 |
SSS ≥8 (%) | 7 | 18 | 6 | .0010 |
SRS | 1.1 ± 3.0 (0–27) | 2.6 ± 5.6 (0–25) | 0.9 ± 2.4 (0–27) | .030 |
SDS | 0.8 ± 1.8 (0–12) | 1.0 ± 2.3 (0–10) | 0.8 ± 1.8 (0–12) | .87 |
LVEF (%) | 61.7 ± 15.0 (17–96) | 53.8 ± 14.7 (20–86) | 62.7 ± 14.7 (17–96) | <.0001 |
LVEF <35 (%) | 5 | 10 | 5 | .17 |
LVEF <40 (%) | 9 | 17 | 8 | .048 |
LVEDV (mL) | 91 ± 39 (18–249) | 109 ± 43 (31–224) | 88 ± 38 (18–249) | .0001 |
LVESV (mL) | 39 ± 31 (3–184) | 54 ± 34 (4–179) | 37 ± 30 (3–184) | .0005 |
Hemoglobin, g/dL | 11.7 ± 2.1 (6.6–19.3) | 11.0 ± 2.0 (6.6–15.3) | 11.8 ± 2.1 (6.7–19.3) | .014 |
Creatinine (mg/dL) | 2.2 ± 1.3 (0.76–10.9) | 2.4 ± 1.3 (0.86–6.7) | 2.2 ± 1.3 (0.76–10.9) | .035 |
eGFR (mL/minute/1.73 m2) | 29.0 ± 12.8 (3.0–71.3) | 25.6 ± 13.2 (5.8–53.1) | 29.4 ± 12.7 (3.0–71.3) | .032 |
eGFR <30 mL/minute/1.73 m2 (%) | 52 | 63 | 51 | .092 |
eGFR <15 mL/minute/1.73 m2 (%) | 19 | 28 | 17 | .065 |
Triglyceride (mg/dL) | 154 ± 97 (10-954) | 152 ± 88 (37–401) | 155 ± 98 (10–954) | .80 |
LDL-C (mg/dL) | 108 ± 40 (8-492) | 106 ± 39 (9–221) | 108 ± 40 (8–492) | .91 |
HDL-C (mg/dL) | 48 ± 15 (21-117) | 47 ± 18 (26–117) | 48 ± 14 (21–111) | .20 |
CRP (mg/dL) | 0.4 ± 1.0 (0-10.1) | 0.8 ± 1.6 (0–6.9) | 0.4 ± 0.9 (0–10.1) | .002 |
CRP ≥0.3 mg/dL (%) | 26 | 47 | 24 | <.0003 |
HbA1c (%) | 6.0 ± 1.1 (4.0-15.5) | 6.1 ± 1.2 (4.5–9.6) | 5.9 ± 1.1 (4.0–15.5) | .78 |
ACE-I (%) | 14 | 20 | 13 | .27 |
ARB (%) | 64 | 60 | 65 | .21 |
Statin (%) | 42 | 43 | 41 | 1.00 |
Beta blocker (%) | 30 | 38 | 29 | .36 |
Aspirin (%) | 30 | 32 | 29 | 1.00 |
MPI Findings
Cardiac Events
Survival Curves
Potential Predictors for Cardiac Events
Wald χ2 | Hazard Ratio | Lower 95% | Upper 95% |
P
| |
---|---|---|---|---|---|
Age, per year | 0.14 | 1.005 | 0.981 | 1.029 | .71 |
Male vs female | 0.22 | 1.135 | 0.667 | 1.928 | .64 |
BMI (kg/m2) | 0.11 | 0.989 | 0.926 | 1.056 | .74 |
Smoking vs nonsmoking | 3.11 | 2.033 | 0.924 | 4.471 | .08 |
Hypertension | 0.11 | 0.868 | 0.374 | 2.018 | .74 |
Diabetes | 0.96 | 1.289 | 0.776 | 2.140 | .33 |
Dyslipidemia | 0.02 | 1.039 | 0.627 | 1.724 | .88 |
Peripheral artery disease | 0.26 | 1.268 | 0.507 | 3.169 | .61 |
Cerebral infarction | 0.37 | 0.728 | 0.264 | 2.008 | .54 |
Typical chest pain | 0.007 | 1.023 | 0.602 | 1.738 | .93 |
Dyspnea or palpitation suggesting ischemia | 0.17 | 0.899 | 0.539 | 1.498 | .68 |
ECG abnormalities | 6.33 | 1.976 | 1.163 | 3.359 | .012 |
SSS, per increment | 16.55 | 1.090 | 1.046 | 1.136 | <.0001 |
SRS, per increment | 19.77 | 1.103 | 1.056 | 1.151 | <.0001 |
SDS, per increment | 0.82 | 1.057 | 0.937 | 1.192 | .37 |
LVEF, per % | 19.35 | 0.967 | 0.952 | 0.981 | <.0001 |
LVEDV, per mL | 16.61 | 1.011 | 1.006 | 1.016 | <.0001 |
LVESV, per mL | 17.09 | 1.012 | 1.006 | 1.018 | <.0001 |
Hemoglobin, per g/dL | 7.85 | 0.822 | 0.716 | 0.943 | .005 |
Creatinine, per mg/dL | 3.41 | 1.166 | 0.991 | 1.373 | .065 |
eGFR, per mL/minute/1.73m2 | 5.46 | 0.976 | 0.956 | 0.996 | .020 |
Triglyceride, per mg/dl | 0.10 | 1.000 | 0.997 | 1.002 | .75 |
LDL-C, per mg/dl | 0.23 | 0.998 | 0.992 | 1.005 | .63 |
HDL-C, per mg/dl | 0.25 | 0.995 | 0.978 | 1.014 | .62 |
CRP, per mg/dL | 10.78 | 1.258 | 1.097 | 1.443 | .001 |
HbA1c, per % | 0.86 | 1.096 | 0.903 | 1.329 | .35 |
ACE-I, user vs nonuser | 1.65 | 1.514 | 0.804 | 2.850 | .20 |
ARB, user vs nonuser | 1.96 | 0.691 | 0.412 | 1.159 | .16 |
Statin, user vs nonuser | 0.01 | 0.974 | 0.585 | 1.623 | .92 |
Beta blocker, user vs nonuser | 1.13 | 1.326 | 0.788 | 2.231 | .29 |
Aspirin, user vs nonuser | 0.001 | 1.010 | 0.586 | 1.740 | .97 |
Categorical variables | Univariate | Multivariate | ||||||
---|---|---|---|---|---|---|---|---|
Hazard ratio | 95% CI |
P
| Hazard ratio | 95% CI |
P
| |||
Lower | Upper | Lower | Upper | |||||
SSS ≥8 | 3.366 | 1.750 | 6.476 | <.001 | 2.68 | 1.36 | 5.31 | .005 |
eGFR <15 mL/minute/1.73 m2 | 1.870 | 1.066 | 3.297 | .030 | 1.79 | 1.02 | 3.16 | .042 |
CRP ≥0.3 mg/dL | 2.718 | 1.630 | 4.531 | <.001 | 2.51 | 1.50 | 4.20 | <.001 |
SSS ≥4 | 1.992 | 1.147 | 3.460 | .015 | ||||
LVEF <40 | 2.260 | 1.145 | 4.463 | .019 | ||||
eGFR <30 mL/minute/1.73 m2 | 1.709 | 1.011 | 2.890 | .046 |