title: Accuracy of exercise stress technetium 99m sestamibi SPECT imaging in the evaluation of the extent and location of coronary artery disease in patients with an earlier myocardial infarction.
abstract: BACKGROUND
  This study assessed the accuracy of exercise methoxy isobutyl isonitrile (MIBI) single photon emission computed tomography (SPECT) in the evaluation of the extent of coronary artery disease (CAD) in patients with an earlier myocardial infarction.
  
  
  RESULTS
  We studied 135 patients (mean age, 57+/-10 years; 115 men) at a mean of 4.1 years (median, 1 year) after myocardial infarction with symptom-limited bicycle exercise stress and rest MIBI SPECT imaging. Coronary angiography was performed within 3 months. Significant CAD was defined as a stenosis of 50% or larger in luminal diameter in 1 or more major coronary arteries. Myocardial perfusion defects (fixed, reversible, or both) were detected in 107 of the 113 patients with significant CAD and in 10 of the 22 patients without significant CAD (sensitivity, 95%; CI, 91 to 99; specificity, 55%; CI, 46 to 63, and accuracy, 88%; CI, 82 to 94). The specificity rate increased to 73% (CI, 65 to 80) by using only reversible perfusion defects as a means of predicting CAD. Reversible perfusion abnormalities were more frequent in patients with multivessel CAD than in patients with single-vessel CAD (51 of 64 [80%] vs. 27 of 49 [55%], P<.01). Myocardial perfusion abnormalities in 2 vascular regions, which is suggestive of multivessel CAD, were detected in 35 of the 64 patients with and in 9 of the 71 patients without multivessel CAD (sensitivity for detecting CAD in more than one vascular region, 55%; CI, 46 to 63, specificity, 87%; CI, 81 to 93, and accuracy, 72%; CI, 64 to 80). The sensitivity rates for the diagnosis of left anterior descending coronary artery, left circumflex, and right coronary artery based on any defect were 80%, 70%, and 63%, respectively. The corresponding specificity rates were 70%, 76%, and 73%, respectively.
  
  
  CONCLUSIONS
  Exercise MIBI SPECT imaging is an accurate method for the diagnosis and localization of CAD in patients with an earlier myocardial infarction. The technique provides a high specificity and moderate sensitivity for the diagnosis of multivessel CAD on the basis of myocardial perfusion abnormalities in more than 1 vascular region.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA. EIHendy.Abdou@mayo.Edu
authors.forename: A
authors.initials: A
authors.lastname: Elhendy
authors.forename: F B
authors.initials: FB
authors.lastname: Sozzi
authors.forename: R T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: J J
authors.initials: JJ
authors.lastname: Bax
authors.forename: M L
authors.initials: ML
authors.lastname: Geleijnse
authors.forename: R
authors.initials: R
authors.lastname: Valkema
authors.forename: E P
authors.initials: EP
authors.lastname: Krenning
authors.forename: J R
authors.initials: JR
authors.lastname: Roelandt
mesh_terms: D000328:Adult; D003066:Coenzyme A Ligases; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D003066:Coenzyme A Ligases