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

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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

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Technetium Tc 99m Sestamibi
Dipyridamole
Chest Pain
Perfusion
Tomography
Exercise
Thallium
Myocardial Infarction
Myocardial Perfusion Imaging
Angina Pectoris
Disease-Free Survival
Diabetes Mellitus
Heart Failure
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic value of dipyridamole technetium-99m sestamibi myocardial tomography in patients with stable chest pain who are unable to exercise. / Stratmann, Henry G.; Tamesis, Beaver R.; Younis, Liwa T.; Wittry, Mark D.; Douglas Miller, D.

In: The American Journal of Cardiology, Vol. 73, No. 9, 01.04.1994, p. 647-652.

Research output: Contribution to journalArticle

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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.",
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