Dipyridamole technetium 99m sestamibi myocardial tomography as an independent predictor of cardiac event-free survival after acute ischemic events.

Abstract

A total of 137 consecutive patients with recent uncomplicated myocardial infarction (n = 31) or unstable angina (n = 106) were studied to determine the relative prognostic value of predischarge clinical risk stratification and intravenous dipyridamole stress sestamibi (MIBI) myocardial tomography in patients unable to exercise maximally after an acute ischemic coronary event. Patients were followed up after the index study for 10 +/- 5 months (range 1 to 23 months) to ascertain cardiac events that occurred in 20 patients (15%): nonfatal myocardial infarction (n = 5) or cardiac death (n = 15). Cardiac event rates were 35% in patients with a recent myocardial infarction and 8% in the group with unstable angina (p < 0.001). Patients with these cardiac events had more frequent abnormal MIBI study results, fixed defects, and reversible plus fixed (combined) defects (all p < 0.05). The univariate relative risk of death or myocardial infarction associated with an abnormal MIBI study was 6.0 (95% confidence limits 0.8 to 44.7). Multivariate stepwise logistic regression models identified an abnormal MIBI study and either fixed or reversible MIBI defects as being predictive of death or myocardial infarction (all p < 0.05). The Mantel-Haentzel 1-year cardiac event-free survival rate was excellent in 27 patients with a normal MIBI single-photon computed emission tomographic scan (100%) but significantly reduced in the 110 patients with an abnormal MIBI study (80%; p < 0.05 vs normal subjects). The presence of combined MIBI defects was associated with the poorest event-free survival rate (66%; difference not significant vs fixed or reversible defects only). We conclude that predischarge dipyridamole MIBI tomography provided independent prognostic information in this population of patients who were unable to exercise after a recent acute ischemic coronary event.