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Prognostic Value of Myocardial Ischemia in Patients with Uncomplicated Acute Myocardial Infarction: Direct Comparison of Stress Echocardiography and Myocardial Perfusion Imaging

¹ Department of Biomorphological and Functional Sciences, University Federico II, Napoli, Italy
² Institute of Biostructure and Bioimages of the National Council of Research, Napoli, Italy
³ Neuromed, Pozzilli, Italy
⁴ Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University Federico II, Napoli, Italy

View larger version (15K): [in a new window]   FIGURE 1. Concordance between myocardial perfusion SPECT and DSE for classification of patients as nonischemic or ischemic.

View larger version (10K): [in a new window]   FIGURE 2. Event-free survival curves by Kaplan–Meier analysis in patients without or with ischemia at myocardial perfusion SPECT. Numbers of patients available for follow-up at 0, 10, 20, 30, 40, 50, and 60 mo were, respectively, 39, 39, 38, 31, 29, 17, and 10; and 55, 51, 42, 33, 26, 22, and 11.

View larger version (13K): [in a new window]   FIGURE 3. Event-free survival curves by Kaplan–Meier analysis in patients without ischemia and in those with mild or moderate-to-severe ischemia at myocardial perfusion SPECT. Numbers of patients available for follow-up at 0, 10, 20, 30, 40, 50, and 60 mo were, respectively, 39, 39, 38, 31, 29, 17, and 10; 34, 31, 28, 19, 18, 14, and 5; and 21, 20, 14, 14, 8, 8, and 6. Mod-sev = moderate to severe.

View larger version (10K): [in a new window]   FIGURE 4. Event-free survival curves by Kaplan–Meier analysis in patients without or with myocardial ischemia at DSE. Numbers of patients available for follow-up at 0, 10, 20, 30, 40, 50, and 60 mo were, respectively, 31, 30, 26, 19, 18, 11, and 4; and 63, 60, 54, 45, 37, 28, and 17. NS = not significant.

View larger version (10K): [in a new window]   FIGURE 5. Event-free survival curves by Kaplan–Meier analysis in patients with worsening or biphasic patterns at DSE. Numbers of patients available for follow-up at 0, 10, 20, 30, 40, 50, and 60 mo were, respectively, 47, 45, 45, 36, 31, 24, and 13; and 16, 15, 9, 9, 6, 4, and 4.

View larger version (7K): [in a new window]   FIGURE 6. Incremental prognostic value for cardiac events (global 2 values on y-axis) obtained considering in hierarchical order: clinical data; clinical data and left ventricular ejection fraction (LVEF); clinical data, LVEF, and DSE; clinical data, LVEF, DSE, and SPECT. NS = not significant.

View larger version (12K): [in a new window]   FIGURE 7. Event-free survival curves by Kaplan–Meier analysis in patients with ischemia and discordant results between myocardial perfusion DSE and SPECT. Numbers of patients available for follow-up at 0, 10, 20, 30, 40, 50, and 60 mo were, respectively, 17, 17, 17, 15, 14, 9, and 6; and 9, 8, 5, 3, 3, 3, and 0.