V. Chiamvimonvat et al., Prognostic value of dipyridamole SPECT imaging in low-risk patients after myocardial infarction, J NUCL CARD, 8(2), 2001, pp. 136-143
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.