Faculty Collaboration Database

Comparison of the prognostic value of normal regadenoson with normal adenosine myocardial perfusion imaging with propensity score matching. JACC Cardiovasc Imaging 2012 Oct;5(10):1014-21

Date

10/13/2012

Pubmed ID

23058068

DOI

10.1016/j.jcmg.2012.04.009

Scopus ID

2-s2.0-84867382259 (requires institutional sign-in at Scopus site)   47 Citations

Abstract

OBJECTIVES: The aim of this study was to test the hypothesis that patients with normal regadenoson myocardial perfusion imaging (MPI) have a low rate of cardiac events, similar to patients with normal adenosine MPI.

BACKGROUND: Regadenoson, a new selective adenosine A(2A) receptor agonist, is now a widely used stress agent for MPI. The low rate of cardiac events in patients with normal adenosine MPI is well-documented, but the prognostic implications of a normal regadenoson MPI have not been examined and compared with those with adenosine.

METHODS: Data on primary composite endpoint (cardiac death, myocardial infarction, and coronary revascularization) were collected for 2,000 patients (1,000 regadenoson, and 1,000 adenosine stress) with normal myocardial perfusion and left ventricular ejection fraction referred for vasodilator MPI. In addition, propensity scores were used to assemble a balanced cohort of 505 pairs of patients who were balanced on 36 baseline characteristics.

RESULTS: The primary endpoint occurred in 21 (2.1%; 1.1%/year) patients in the regadenoson group and 33 (3.3%; 1.7%/year) patients in the adenosine group (hazard ratio [HR] for regadenoson vs. adenosine: 0.62; 95% confidence interval [CI]: 0.36 to 1.08; p = 0.090). In the propensity-matched pairs, the primary endpoint occurred in 7 (1.4%; 0.7%/year) patients in the regadenoson group and 13 (2.6%; 1.3%/year) patients in the adenosine group (matched HR: 0.58; 95% CI: 0.23 to 1.48; p = 0.257). Cardiac deaths were infrequent in the entire sample and in the propensity-matched groups; the cardiac death rate was 0.9%/year and 1.15%/year in the regadenoson and adenosine groups (HR: 0.77; 95% CI: 0.42 to 1.43; p = 0.404) in the pre-match sample and 0.5%/year and 0.7%/year in the matched groups, respectively (HR: 0.83; 95% CI: 0.25 to 2.73; p = 0.763).

CONCLUSIONS: Major cardiac events are infrequent in patients with normal regadenoson MPI. These findings provide assurance that normal MPI using a simpler stress protocol with regadenoson provides prognostic data similar to normal adenosine MPI.

Author List

Iqbal FM, Hage FG, Ahmed A, Dean PJ, Raslan S, Heo J, Iskandrian AE

Author

Fahad M. Iqbal MD Staff Physician in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenosine
Adenosine A2 Receptor Agonists
Aged
Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography
Cause of Death
Chi-Square Distribution
Female
Heart Diseases
Humans
Incidence
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction
Myocardial Perfusion Imaging
Myocardial Revascularization
Predictive Value of Tests
Prognosis
Propensity Score
Proportional Hazards Models
Purines
Pyrazoles
Reference Values
Risk Factors
Stroke Volume
Time Factors
Vasodilator Agents
Ventricular Function, Left