The Registry of Fast Myocardial Perfusion Imaging with Next-Generation SPECT (REFINE SPECT) has been expanded to include more patients and CT attenuation correction imaging. We present the design and initial results from the updated registry. Methods: The updated REFINE SPECT is a multicenter, international registry with clinical data and image files. SPECT images were processed by quantitative software and CT images by deep learning software detecting coronary artery calcium (CAC). Patients were followed for major adverse cardiovascular events (MACEs) (death, myocardial infarction, unstable angina, late revascularization). Results: The registry included scans from 45,252 patients from 13 centers (55.9% male, 64.7 ± 11.8 y). Correlating invasive coronary angiography was available for 3,786 (8.4%) patients. CT attenuation correction imaging was available for 13,405 patients. MACEs occurred in 6,514 (14.4%) patients during a median follow-up of 3.6 y (interquartile range, 2.5–4.8 y). Patients with a stress total perfusion deficit of 5% to less than 10% (unadjusted hazard ratio [HR], 2.42; 95% CI, 2.23–2.62) and a stress total perfusion deficit of at least 10% (unadjusted HR, 3.85; 95% CI, 3.56–4.16) were more likely to experience MACEs. Patients with a deep learning CAC score of 101–400 (unadjusted HR, 3.09; 95% CI, 2.57–3.72) and a CAC of more than 400 (unadjusted HR, 5.17; 95% CI, 4.41–6.05) were at increased risk of MACEs. Conclusion: The REFINE SPECT registry contains a comprehensive set of imaging and clinical variables. It will aid in understanding the value of SPECT myocardial perfusion imaging, leverage hybrid imaging, and facilitate validation of new artificial intelligence tools for improving prediction of adverse outcomes incorporating multimodality imaging.

使用下一代 SPECT 的快速心肌灌注成像 （REFINE SPECT） 已扩展至包括更多患者和 CT 衰减校正成像。我们介绍了更新后的注册表的设计和初步结果。方法：更新后的 REFINE SPECT 是一个包含临床数据和图像文件的多中心国际登记处。SPECT 图像通过定量软件处理，CT 图像通过深度学习软件处理冠状动脉钙化 （CAC）。随访患者主要不良心血管事件 （MACE） （死亡、心肌梗死、不稳定型心绞痛、晚期血运重建）。结果：登记包括来自 45,252 个中心的 13 名患者的扫描 （55.9% 为男性，64.7 ± 11.8 岁）。3,786 例 （8.4%） 患者可进行相关性有创冠状动脉造影。CT 衰减校正成像可用于 13,405 例患者。在中位随访 3.6 年 （四分位距，2.5-4.8 y） 期间，6,514 例 （14.4%） 患者发生了 MACE。应激总灌注缺失 5% 至低于 10%（未校正风险比 [HR]，2.42;95% CI，2.23-2.62）和应激总灌注缺陷至少 10%（未校正 HR，3.85;95% CI，3.56-4.16）的患者更容易发生 MACE。深度学习 CAC 评分为 101-400（未调整 HR，3.09;95% CI，2.57-3.72）且 CAC 超过 400（未调整 HR，5.17;95% CI，4.41-6.05）的患者发生 MACE 的风险增加。结论：REFINE SPECT 登记包含一套全面的影像学和临床变量。 它将有助于了解 SPECT 心肌灌注成像的价值，利用混合成像，并促进验证新的人工智能工具，以改进结合多模态成像的不良结果预测。