title: Relationship between the location of the most severe myocardial perfusion defects, the most severe coronary artery stenosis, and the site of subsequent myocardial infarction.
abstract: This study evaluated the relationship between the location of the most severe myocardial perfusion defects, the most severe coronary artery stenosis, and the site of subsequent acute myocardial infarction (AMI).
  
  
  METHODS
  Of 3,180 patients who were admitted with a diagnosis of AMI, we identified 44 patients who had undergone previous myocardial perfusion SPECT. Thirty-one of them also had previous coronary angiography. The relationship between the location of the myocardial perfusion defects, the coronary artery stenosis, and the site of subsequent AMI was studied in these patients.
  
  
  RESULTS
  The concordance between the location of the most severe reversible defects detected by SPECT and the site of subsequent AMI was 71% (kappa = 0.499). The concordance between the most severe stenosis detected by coronary angiography and the site of subsequent AMI was 64% (kappa = 0.451). However, kappa values for SPECT and coronary angiography were good when the interval between these investigations and subsequent AMI was <3 mo (0.724 and 0.661, respectively), for moderate to severe perfusion defects (0.719), and for 90%-99% coronary stenosis (0.626).
  
  
  CONCLUSIONS
  The culprit lesion is not always the one that is manifested by the most severe reversible perfusion defect or the most critical coronary artery stenosis. Myocardial SPECT and coronary angiography can predict the location of a future AMI in 71% and 64% of patients, respectively. The percentage is higher when the interval between investigations and subsequent AMI is <3 mo, for moderate to severe perfusion defects, and for 90%-99% coronary stenosis.
authors.affiliation: Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Candell-Riera
authors.forename: O
authors.initials: O
authors.lastname: Pereztol-Valdés
authors.forename: C
authors.initials: C
authors.lastname: Santana-Boado
authors.forename: M
authors.initials: M
authors.lastname: Missorici
authors.forename: G
authors.initials: G
authors.lastname: Oller-Martínez
authors.forename: S
authors.initials: S
authors.lastname: Aguadé-Bruix
authors.forename: J
authors.initials: J
authors.lastname: Castell-Conesa
authors.forename: M
authors.initials: M
authors.lastname: Simó
authors.forename: M J
authors.initials: MJ
authors.lastname: Díez-Castro
authors.forename: J
authors.initials: J
authors.lastname: Soler-Soler
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003326:Coronary Circulation; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi