PROGNOSTIC EVALUATION OF PATIENTS AFTER MYOCARDIAL-INFARCTION - INCREMENTAL VALUE OF SESTAMIBI SINGLE-PHOTON EMISSION COMPUTED-TOMOGRAPHY AND ECHOCARDIOGRAPHY

Background. This study compares the prognostic value of Tc-99m-labeled methoxyisobutyl isonitrile (MIBI) single-photon emission computed tom ographic (SPECT) imaging, echocardiography, and other clinical and lab oratory prognostic factors in the long-term risk stratification of pat ients with stable uncomplicated infarcts. Methods and Results. Ninety- one consecutive patients affected by a first myocardial infarction wit hout serious complications were enrolled, After at least 3 months from the infarction, they were submitted to stress-rest MIBI SPECT and res t echocardiography. Eighty-six patients completed a follow-up of at le ast 4 years (range 48 to 72 months; mean 55 months). By univariate (lo g-rank test) and multivariate analysis (Cox proportional hazards model ), the main clinical, electrocardiographic, scintigraphic, and echocar diographic findings were evaluated and correlated statistically with t he incidence of ensuing cardiac events. Twenty-five patients had cardi ac events during the follow-up (four cardiac deaths, four myocardial i nfarctions, and 17 cases of unstable angina). At the multivariate anal ysis, the presence of reversible defects on MIBI SPECT (p = 0.008 and relative risk [RR] = 7.09), the wall motion score index, and the eject ion fraction at echocardiography (respectively, p = 0.010, RR = 3.67, p = 0.036, and RR = 3.12), and stress angina (p = 0.007 and RR = 3.40) mere significant and independent prognostic factors. Conclusions. In our long-term follow-up, MIBI SPECT and echocardiography appeared to b e significant and independent prognostic tools in the risk stratificat ion of patients with stable, uncomplicated infarcts, furnishing comple mentary information. The reversibility of MIBI defects appeared the be st indicator for a bad prognosis.