Independent prognostic value of intravenous dipyridamole with technetium-99m sestamibi tomographic imaging in predicting cardiac events and cardiac-related hospital admissions.
OBJECTIVE
This study sought to establish the prognostic value of intravenous dipyridamole technetium-99m (Tc-99m) sestamibi single-photon emission computed tomographic (SPECT) myocardial perfusion imaging.


BACKGROUND
Optimal management of patients with coronary artery disease involves strategies designed to reduce the risk of myocardial infarction and cardiac death. The role of myocardial perfusion imaging using newer clinical techniques to determine risk and possible benefit from therapy has not been evaluated.


METHODS
Myocardial imaging results were classified as normal or abnormal (fixed or reversible defects; small, moderate or large). Follow-up evaluation of all patients included the occurrence of cardiac death or nonfatal myocardial infarction and other cardiac-related hospital admissions.


RESULTS
During a mean (+/- SD) follow-up period of 12.8 +/- 6.8 months in 512 patients, 25 had a cardiac event. Patients with abnormal perfusion had significantly more cardiac events than those with normal perfusion (22 vs. 3, p < 0.01). Patients with reversible defects had the highest event rates (8.6%), and those with normal study results had a very low event rate (1.4%). Large defects were strongly associated with more cardiac events and hospital admissions than either normal scan results or abnormal results showing small defects.


CONCLUSIONS
Patients with normal study results or a small defect after intravenous dipyridamole Tc-99m sestamibi SPECT imaging had an excellent short-term prognosis. Those with abnormal results (reversible or large defect) had an increased risk of subsequent cardiac death, nonfatal myocardial infarction and other cardiac-related hospital admissions.
Heller
G V
GV
Nuclear Cardiology Laboratory, Hartford Hospital, Connecticut 06102, USA.
Herman
S D
SD
Travin
M I
MI
Baron
J I
JI
Santos-Ocampo
C
C
McClellan
J R
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004176:Dipyridamole / Q000008:administration & dosage; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006760:Hospitalization; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D017256:Technetium Tc 99m Sestamibi; D014055:Tomography, Emission-Computed; D014665:Vasodilator Agents / Q000008:administration & dosage
D014665:Vasodilator Agents; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi