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Reduced global sMBF was associated with events (area under the receiver operating characteristic curve 0.622, 95% confidence interval (95% CI) 0.538\u20130.707, <jats:italic>p<\/jats:italic>\u2009=\u20090.006). Reduced global sMBF (&lt;\u20092.2\u00a0ml\/g\/min) was found in 22.8%, preserved global sMBF despite segmentally reduced sMBF in 35.3%, and normal sMBF in 41.9% of patients. Compared with normal sMBF, reduced global sMBF was associated with the highest risk of events (adjusted hazard ratio (HR) 6.970, 95% CI 2.271\u201321.396, <jats:italic>p<\/jats:italic>\u2009=\u20090.001), whereas segmentally reduced sMBF combined with preserved global MBF predicted an intermediate risk (adjusted HR 3.251, 95% CI 1.030\u201310.257, <jats:italic>p<\/jats:italic>\u2009=\u20090.044). The addition of global or segmental reduction of sMBF to clinical risk factors improved risk prediction (net reclassification index 0.498, 95% CI 0.118\u20130.879, <jats:italic>p<\/jats:italic>\u2009=\u20090.010, and 0.583, 95% CI 0.203\u20130.963, <jats:italic>p<\/jats:italic>\u2009=\u20090.002, respectively).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>In symptomatic patients evaluated for suspected obstructive CAD, reduced global sMBF by [<jats:sup>15<\/jats:sup>O] water PET identifies those at the highest risk of adverse cardiac events, whereas segmental reduction of sMBF with preserved global sMBF is associated with an intermediate event risk.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00259-020-05093-2","type":"journal-article","created":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T03:02:21Z","timestamp":1605063741000},"page":"1434-1444","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Global and segmental absolute stress myocardial blood flow in prediction of cardiac events: [15O] water positron emission tomography study"],"prefix":"10.1007","volume":"48","author":[{"given":"Esa","family":"Harjulahti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teemu","family":"Maaniitty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wail","family":"Nammas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iida","family":"Stenstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fausto","family":"Biancari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen J.","family":"Bax","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juhani","family":"Knuuti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2488-0893","authenticated-orcid":false,"given":"Antti","family":"Saraste","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,11,11]]},"reference":[{"issue":"3","key":"5093_CR1","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","volume":"41","author":"J Knuuti","year":"2020","unstructured":"Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. 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Saraste and Knuuti have been supported by the Finnish Foundation for Cardiovascular Research and State Research Funding of Turku University Hospital. Dr. Bax reports that the Department of Cardiology, Leiden University Medical Center, The Netherlands, has received unrestricted research grants from Edwards Lifescience, Medtronic, Boston Scientific, Biotronik, and GE Healthcare. Dr. Bax reports being a speaker bureau at Abbott. Dr. Knuuti reports being a speaker bureau at GE Healthcare, Merck, Lundbeck, and Bayer and consultancy fees from GE Healthcare and AstraZeneca. Dr. Saraste reports fees for lectures from Abbott, Amgen, Astra Zeneca, Bayer, and Novartis and fees for consultancy from Amgen and Astra Zenaca. Dr. Harjulahti, Dr. Stenstr\u00f6m, Dr. Maaniitty, Dr. Biancari, and Dr. Nammas report no relationship with industry.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The Ethics Committee of the Hospital District of Southwest Finland approved the study protocol and waived the need for informed consent by patients. The Finnish Institute for Health and Welfare gave permission to the retrospective collection of the clinical data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The Ethics Committee of the Hospital District of Southwest Finland waived the need for informed consent by patients.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not appropriate","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The Carimas software is available at","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code availability"}}]}}