PROGNOSTIC VALUE OF DOBUTAMINE-ATROPINE STRESS TC-99M SESTAMIBI PERFUSION SCINTIGRAPHY IN PATIENTS WITH CHEST PAIN

Objectives. This study investigated the prognostic value of dobutamine -atropine technetium-99m (Tc-99m) sestamibi single photon emission com puted tomographic (SPECT) myocardial perfusion imaging. Background Dob utamine atropine Tc-99m sestamibi SPECT imaging is an accurate method for the detection of coronary disease, However, the prognostic value o f this stress modality has not been assessed. Methods. Three hundred n inety-two consecutive patients with chest pain (mean [+/-SD] age 60 +/ - 12 years; 220 men, 190 with a previous myocardial infarction) underw ent a dobutamine-atropine Tc-99m sestamibi SPECT scintigraphic study. Patients were followed up for 22 +/- 13 months to determine the univar iate and multivariate variables associated with hard cardiac events (c ardiac death, nonfatal myocardial infarction), to define their event-f ree survival and to determine whether the extent and severity of rever sible perfusion defects correlated with events. Results. Forty-four pa tients (11%) had hard cardiac events. Multivariate models demonstrated that older age (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.0 to 4.4), history of heart failure (OR 2.6, 95% CI 1.3 to 5.2), abnorm al sestamibi scan results (OR 10.0, 95% CI 2.3 to 43.0) and reversible perfusion defects (OR 3.2, 95% CI 1.6 to 6.4) had independent predict ive value. Patients without perfusion defects, with fixed defects alon e, reversible defects alone and fixed plus reversible defects had annu al hard cardiac event rates of 0.8%, 6.8%, 8.1% and 11.6%, respectivel y. Patients with increasing reversible defect scores had increasing an nual event rates of 2.1%, 5.0%, 5.5%, 13.0% and 14.6%, respectively. C onclusions. Dobutamine atropine stress Tc-99m sestamibi SPECT imaging provides excellent prognostic information. The single most important i ndependent predictor for future hard cardiac events is an abnormal pat tern, and a reversible defect provides additional, independent prognos tic information. Moreover, the extent and severity of reversible defec ts are major determinants for prognosis.