Prognostic value of predischarge dipyridamole technetium 99m sestamibi myocardial tomography in medically treated patients with unstable angina

Henry G. Stratmann, Beaver R. Tamesis, Liwa T. Younis, Mark D. Wittry, Maryellen Amato, Donald D Miller

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Recently developed unstable angina clinical practice guidelines have recommended risk stratification with dipyridamole thallium-201 myocardial imaging in patients at "intermediate" pretest clinical risk who cannot exercise maximally. The prognostic value of predischarge dipyridamole technetium 99m sestamibi (MIBI) tomography has not been assessed in this clinical setting. To this end, 128 medically treated patients with unstable angina at intermediate pretest clinical risk underwent follow-up for 16 ± 11 (mean ± SD) months after predischarge intravenous dipyridamole MIBI tomography. An abnormal MIBI scan result was present in 99 patients (77%), of whom 47 had one or more reversible and 76 had one or more fixed perfusion defects. Cardiac events occurred in 68 (53%) patients after dipyridamole testing: recurrent unstable angina (n = 36), nonfatal acute myocardial infarction (n = 6), or death (n = 26). A cardiac event occurred in 10% of patients with normal MIBI tomography results compared with 69% of those with abnormal results (p < 0.01). Event rates associated with specific perfusion defects were similar (reversible = 68%; fixed = 71%) and were greater than rates in patients without defects (both p < 0.05). Clinical variables associated with increased risk of cardiac events by univariate analysis included a history of congestive heart failure, prior myocardial infarction, and diabetes mellitus (all p < 0.05). Independent multivariable predictors (Cox proportional hazards model) of any cardiac event were an abnormal result of MIBI scan (relative risk [RR] = 4.3, 95% confidence interval [CI] 1.5 to 12.0) and a reversible (RR = 1.8, 95% CI 1.1 to 2.9) or a fixed perfusion defect (RR = 2.9, 95% CI 1.6 to 5.4). Two-year cardiac event-free survival was significantly lower in patients with an abnormal MIBI study result (p < 0.0002). We conclude that the use of predischarge dipyridamole MIBI myocardial tomography provides prognostic information in medically treated patients with unstable angina beyond that available with clinical risk assessment alone. This application of dipyridamole MIBI myocardial imaging is consistent with the recommended use of dipyridamole thallium-201 imaging in published unstable angina clinical practice guidelines.

Original languageEnglish (US)
Pages (from-to)734-740
Number of pages7
JournalAmerican Heart Journal
Volume130
Issue number4
DOIs
StatePublished - Jan 1 1995
Externally publishedYes

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Technetium Tc 99m Sestamibi
Dipyridamole
Unstable Angina
Tomography
Perfusion
Thallium
Confidence Intervals
Practice Guidelines
Myocardial Infarction
Proportional Hazards Models
Disease-Free Survival
Diabetes Mellitus
Heart Failure
Exercise

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic value of predischarge dipyridamole technetium 99m sestamibi myocardial tomography in medically treated patients with unstable angina. / Stratmann, Henry G.; Tamesis, Beaver R.; Younis, Liwa T.; Wittry, Mark D.; Amato, Maryellen; Miller, Donald D.

In: American Heart Journal, Vol. 130, No. 4, 01.01.1995, p. 734-740.

Research output: Contribution to journalArticle

Stratmann, Henry G. ; Tamesis, Beaver R. ; Younis, Liwa T. ; Wittry, Mark D. ; Amato, Maryellen ; Miller, Donald D. / Prognostic value of predischarge dipyridamole technetium 99m sestamibi myocardial tomography in medically treated patients with unstable angina. In: American Heart Journal. 1995 ; Vol. 130, No. 4. pp. 734-740.
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