ORIGINAL ARTICLE Long-term prognostic value of low-dose normal stress-only myocardial perfusion imaging by wide beam reconstruction: A competing risk analysis Carmela Nappi, MD, a Wanda Acampa, MD, PhD, a,b Emanuele Nicolai, MD, c Stefania Daniele, MS, b Emilia Zampella, MD, PhD, a Roberta Assante, MD, PhD, a Valeria Gaudieri, MD, b Teresa Mannarino, MD, a Mario Petretta, MD, d and Alberto Cuocolo, MD a a Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy b Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy c IRCCS-SDN, Naples, Italy d Department of Translational Medical Sciences, University Federico II, Naples, Italy Received May 16, 2018; accepted Jul 10, 2018 doi:10.1007/s12350-018-1373-x Background. A normal stress myocardial perfusion single-photon emission computed tomography (MPS) is associated with a good clinical outcome. New iterative algorithms, such as wide beam reconstruction (WBR), which improve image interpretation with half-dose or half- time acquisition, have been proposed for cardiac MPS. The aim of this study was to assess the long-term predictive value of a low-dose normal stress-only MPS with WBR using conventional Anger camera in patients with known or suspected coronary artery disease (CAD). Methods and Results. A total of 2106 patients with known or suspected CAD and normal perfusion at half-dose stress-only MPS protocol were followed for a mean of 6.6 ± 2.7 years. MPS data were reconstructed with WBR iterative algorithm. End-point events were cardiac death or nonfatal myocardial infarction. Noncardiac death was considered the competing event. During follow-up, 149 cardiac events occurred with an annualized event rate of 1.2%. Inde- pendent predictors of cardiac events at Cox analysis were age, male gender, diabetes mellitus, previous myocardial infarction and the need for pharmacologic stress testing. At Fine-Gray analysis the cumulative incidence of cardiac events progressively increases with age and in the presence of diabetes for any combination of gender and stress type. Survival tree analysis confirmed that long-term prognosis considerably varies according of risk factors profile. Conclusions. Low-dose normal stress-only WBR MPS has a reliable long-term prognostic value in patients with suspected or known CAD. This finding supports the introduction of such a method into clinical practice with a consistent dose optimization in the interest of patients and exposed staff. (J Nucl Cardiol 2018) Key Words: SPECT Æ MPI Æ diagnostic and prognostic application Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-018-1373-x) contains sup- plementary material, which is available to authorized users. The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com. Reprint requests: Alberto Cuocolo, MD, Cardiac Imaging, Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy; cuocolo@unina.it 1071-3581/$34.00 Copyright Ó 2018 American Society of Nuclear Cardiology.