Relationship between the location of the most severe myocardial perfusion defects, the most severe coronary artery stenosis, and the site of subsequent myocardial infarction

This study evaluated the relationship between the location of the most seve re myocardial perfusion defects, the most severe coronary artery stenosis, and the site of subsequent acute myocardial infarction (AMI). Methods: Of 3 ,180 patients who were admitted with a diagnosis of AMI, we identified 44 p atients who had undergone previous myocardial perfusion SPECT. Thirty-one o f them also had previous coronary angiography. The relationship between the location of the myocardial perfusion defects, the coronary artery stenosis , and the site of subsequent AMI was studied in these patients. Results: Th e concordance between the location of the most severe reversible defects de tected by SPECT and the site of subsequent AMI was 71% (kappa = 0.499). The concordance between the most severe stenosis detected by coronary angiogra phy and the site of subsequent AMI was 64% (kappa = 0.451). However, K valu es for SPECT and coronary angiography were good when the interval between t hese investigations and subsequent AMI was <3 mo (0.724 and 0.661, respecti vely), for moderate to severe perfusion defects (0.719), and for 90%-99% co ronary stenosis (0.626). Conclusion: The culprit lesion is not always the o ne that is manifested by the most severe reversible perfusion defect or the most critical coronary artery stenosis. Myocardial SPECT and coronary angi ography can predict the location of a future AMI in 71% and 64% of patients , respectively. The percentage is higher when the interval between investig ations and subsequent AMI is <3 mo, for moderate to severe perfusion defect s, and for 90%-99% coronary stenosis.