Adenosine single photon emission computed tomography for assessing risk after myocardial infarction: recent developments.
OBJECTIVE
While the prognostic power of adenosine single photon emission computed tomography myocardial perfusion imaging has been validated in multiple patient populations including those with known or suspected coronary artery disease, the utility of this modality in assessing risk after an acute myocardial infarction in the primary angioplasty era is still a topic of debate.


RESULTS
The INSPIRE trial showed that early adenosine single photon emission computed tomography myocardial perfusion imaging is capable of identifying low-risk patients for early hospital discharge after acute myocardial infarction. This novel study demonstrated that intensive medical therapy is a reasonable strategy in low, intermediate, and high-risk post-myocardial infarction patients with preserved left ventricular function.


CONCLUSIONS
The INSPIRE trial established the role for early adenosine single photon emission computed tomography myocardial perfusion imaging as a tool for risk stratification in stable patients after an acute myocardial infarction and provided evidence that intensive medical therapy is comparable to coronary revascularization in suppressing ischemia and presumably improving cardiac outcomes. It remains to be seen whether these new findings will alter current American College of Cardiology/American Heart Association guidelines, which emphasize a primary role of coronary revascularization in acute coronary syndromes.
Dorfman
Todd A
TA
Division of Cardiovascular Disease, University of Alabama, Birmingham, Alabama, USA. tdorfman@cardmail.dom.uab.edu
Iskandrian
Ami E
AE
D000241:Adenosine; D002986:Clinical Trials as Topic; D018572:Disease-Free Survival; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon
D000241:Adenosine