Prognostic assessment of uncomplicated first myocardial infarction by exercise echocardiography and Tc-99m tetrofosmin gated SPECT

Background. We evaluate the prognostic value of stress echo and gated singl e photon emission computed tomography (SPECT) after a first uncomplicated a cute myocardial infarction, Methods and Results, We used predischarge maximal subjective exercise echoc ardiography and gated SPECT with technetium 99m tetrofosmin to prospectivel y study 103 patients younger than 70 years with a first acute myocardial in farction, During a 12-month follow-up period, 2 patients died, 9 had heart failure, and 29 had ischemic complications (4 reinfarction and 25 angina). Predictive variables for heart failure in multivariate analysis were ejecti on fraction evaluated by echocardiography (odds ratio [OR] 8,5, P = .016) o r by gated SPECT (OR 10,7, P = .009). Predictive variables for ischemic com plications in multivariate analysis were less than 5 metabolic equivalents (METS) in exercise test (OR 5,2, P = ,007) and greater than 15% ischemic ex tent in the polar map (OR 3.6, P = .04) of SPECT. Conclusions. Exercise echocardiography and Tc-99m tetrofosmin gated SPECT w ere predictive for heart failure, but exercise SPECT was the only test with predictive power for ischemic complications.