Prognostic value of dipyridamole SPECT imaging in low-risk patients after myocardial infarction

Background The prognostic value of perfusion imaging was assessed in Ism-ri sk patients after myocardial infarction (MI) and compared with clinical and angiographic variables, Methods and Results, Rest thallium and dipyridamole technetium 99m sestamib i single photon emission computed tomography imaging was performed in 203 ( 91%) low-risk patients 3 to 21 days after MI who were enrolled in a trial o f low dose warfarin sodium and aspirin. Patients were considered low risk w ith planned nonintervention, on the basis of an uncomplicated course after MI, negative submaximal stress electrocardiography, and the absence of sign ificant angiographic disease requiring revascularization, During a minimum follow-up of 12 months, 69 patients (39%) had clinical events: I cardiac de ath, 7 MIs, 26 admissions for unstable angina, 18 coronary by-pass grafting , and 17 angioplasty: Univariate analysis identified the extent of signific ant angiographic stenoses (greater than or equal to 70%) and the extent of scintigraphic defect as predictive of future events, On multivariate analys is? the presence of any. scintigraphic reversibility had the strongest corr elation with clinical events, with better predictive value than angiographi c multivessel stenoses (P = .0006 vs P = ,003), Conclusions. In the low-risk population after MI, scintigraphic: reversibil ity remains a strong predictor of cardiac events, with greater prognostic v alue than angiographic data. The extent of scintigraphic reversibility was directly correlated with clinical events. Therefore scintigraphic imaging r emains clinically relevant for risk stratification in the current low-risk population after MI.