Prediction of Death and Nonfatal Myocardial Infarction in High-Risk Patients: A Comparison Between the Duke Treadmill Score, Peak Exercise Radionuclide Angiography, and SPECT Perfusion Imaging

Radionuclide exercise testing provides prognostic information in patients with known or suspected coronary artery disease (CAD). The relative contribution of 3 noninvasive tests—the Duke treadmill score (DTS), first-pass radionuclide angiography with calculation of the ejection fraction (RNA-EF), and perfusion SPECT—has not been comparatively assessed in a high-risk population undergoing all 3 tests. Methods: We identified 997 patients (75 % male; median age, 60 y) who underwent exercise treadmill testing with RNA-EF and SPECT perfusion imaging as a single test. The relative prognostic power of each test was evaluated in both an unadjusted manner and after adjustment for differences in baseline characteristics using Cox propor-tional hazards models. Results: During a median follow-up of 4.1 y, 175 patients experienced outcome events. Without ad-justment for baseline patient characteristics, each of the mo