title: Prognostic value of dipyridamole technetium-99m sestamibi myocardial tomography in patients with stable chest pain who are unable to exercise.
abstract: Unlike dipyridamole testing with thallium-201, the ability of technetium-99m sestamibi (MIBI) myocardial imaging to evaluate risk of later cardiac events has not been established. In this study, the prognostic value of dipyridamole MIBI myocardial tomography (same-day, rest-stress protocol) was assessed in 534 patients with stable chest pain consistent with angina pectoris. During follow-up (mean 13 +/- 5 months), 58 patients (11%) had a major cardiac event--nonfatal myocardial infarction (n = 14) or cardiac death (n = 44). A history of congestive heart failure, prior myocardial infarction or diabetes mellitus, and either a reversible or fixed myocardial perfusion defect on MIBI scans were univariate and multivariate predictors of increased cardiac risk. Cardiac events occurred in 2% of patients with normal MIBI scans, compared with 15% with abnormal scans, 17% with reversible perfusion defects and 16% with fixed defects (all p < 0.01). Relative risks (univariate Cox analysis) associated with an abnormal MIBI scan, a reversible perfusion defect and a fixed defect were 8.4 (95% confidence interval [CI] 2.6 to 26.8), 1.9 (95% CI 1.1 to 3.2) and 2.4 (95% CI 1.4 to 4.3), respectively. Patients with any kind of perfusion abnormality (reversible or fixed) had a significantly lower cardiac event-free survival than those with normal scans (all p < 0.0001). It is concluded that, as with thallium-201 myocardial scintigraphy, a normal MIBI scan is associated with low cardiac risk, whereas dipyridamole-induced myocardial perfusion defects identify patients with significantly increased risk.
authors.affiliation: Department of Cardiology, St. Louis Veterans Administration Medical Center, Missouri 63125.
authors.forename: H G
authors.initials: HG
authors.lastname: Stratmann
authors.forename: B R
authors.initials: BR
authors.lastname: Tamesis
authors.forename: L T
authors.initials: LT
authors.lastname: Younis
authors.forename: M D
authors.initials: MD
authors.lastname: Wittry
authors.forename: D D
authors.initials: DD
authors.lastname: Miller
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging*; D004176:Dipyridamole; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012146:Rest; D012307:Risk Factors; D016019:Survival Analysis; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi