Prognostic value of myocardial ischemia in patients with uncomplicated acute myocardial infarction: direct comparison of stress echocardiography and myocardial perfusion imaging.
This study directly compared the prognostic value of predischarge dobutamine stress echocardiography (DSE) and dobutamine myocardial SPECT perfusion imaging in patients with prior myocardial infarction.


METHODS
The study population consisted of 146 consecutive patients who underwent predischarge DSE and SPECT with (99m)Tc-sestamibi after a first acute uncomplicated myocardial infarction treated with thrombolysis. Fifty patients who underwent revascularization within 90 d from the imaging studies were excluded. Cardiac death and nonfatal myocardial infarction were considered events. Follow-up was 98% complete in a mean period of 44 +/- 19 mo.


RESULTS
Myocardial ischemia was detectable in 55 (58%) patients at SPECT and in 63 (67%) patients at DSE. Concordance between SPECT and DSE in detecting ischemia was observed in 68 (72%) of the 94 patients (kappa value, 0.41). During the follow-up, there were 20 cardiac events (9 deaths and 11 nonfatal myocardial infarctions). Ischemia at SPECT was a significant predictor of events (hazards ratio = 4.8; 95% confidence interval, 1.4-16.3; P < 0.01). However, ischemia at DSE (biphasic or worsening patterns) was not associated with events, whereas biphasic pattern alone was associated with a poor outcome compared with direct worsening (P < 0.05). Finally, at Cox multivariate analysis, ischemia at SPECT but not biphasic pattern at DSE was a significant independent predictor of events (P < 0.01).


CONCLUSIONS
These results indicate that, after uncomplicated myocardial infarction, ischemia at SPECT is associated with an increased risk of cardiac events at long-term follow-up. However, ischemia at DSE was unable to stratify patients after myocardial infarction.
Acampa
Wanda
W
Department of Biomorphological and Functional Sciences, University Federico II, Napoli, Italy.
Spinelli
Letizia
L
Petretta
Mario
M
De Lauro
Francesco
F
Ibello
Francesco
F
Cuocolo
Alberto
A
D018572:Disease-Free Survival; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
D019275:Radiopharmaceuticals; D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi