Prognostic value of dipyridamole technetium-99m sestamibi myocardial tomography in patients with stable chest pain who are unable to exercise

Henry G. Stratmann, Beaver R. Tamesis, Liwa T. Younis, Mark D. Wittry, D. Douglas Miller

Research output: Contribution to journalArticlepeer-review

75 Scopus citations

Abstract

Unlike dipyridamole testing with thallium-201, the ability of technetium-99m sestamibi (MIBI) myocardial imaging to evaluate risk of later cardiac events has not been established. In this study, the prognostic value of dipyridamole MIBI myocardial tomography (same-day, rest-stress protocol) was assessed in 534 patients with stable chest pain consistent with angina pectoris. During follow-up (mean 13 ± 5 months), 58 patients (11%) had a major cardiac event-nonfatal myocardial infarction (n = 14) or cardiac death (n = 44). A history of congestive heart failure, prior myocardial infarction or diabetes mellitus, and either a reversible or fixed myocardial perfusion defect on MIBI scans were univariate and multivariate predictors of increased cardiac risk. Cardiac events occurred in 2% of patients with normal MIBI scans, compared with 15% with abnormal scans, 17% with reversible perfusion defects and 16% with fixed defects (all p <0.01). Relative risks (univariate Cox analysis) associated with an abnormal MIBI scan, a reversible perfusion defect and a fixed defect were 8.4 (95% confidence interval [Cl] 2.6 to 26.8), 1.9 (95% Cl 1.1 to 3.2) and 2.4 (95% Cl 1.4 to 4.3), respectively. Patients with any kind of perfusion abnormality (reversible or fixed) had a significantly lower cardiac event free survival than those with normal scans (all p <0.0001). It is concluded that, as with thallium-201 myocardial scintigraphy, a normal MIBI scan is associated with low cardiac risk, whereas dipyridamole-induced myocardial perfusion defects identify patients with significantly increased risk.

Original languageEnglish (US)
Pages (from-to)647-652
Number of pages6
JournalThe American Journal of Cardiology
Volume73
Issue number9
DOIs
StatePublished - Apr 1 1994
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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