@article {Acampa417, author = {Wanda Acampa and Letizia Spinelli and Mario Petretta and Francesco De Lauro and Francesco Ibello and Alberto Cuocolo}, title = {Prognostic Value of Myocardial Ischemia in Patients with Uncomplicated Acute Myocardial Infarction: Direct Comparison of Stress Echocardiography and Myocardial Perfusion Imaging}, volume = {46}, number = {3}, pages = {417--423}, year = {2005}, publisher = {Society of Nuclear Medicine}, abstract = {This study directly compared the prognostic value of predischarge dobutamine stress echocardiography (DSE) and dobutamine myocardial SPECT perfusion imaging in patients with prior myocardial infarction. Methods: The study population consisted of 146 consecutive patients who underwent predischarge DSE and SPECT with 99mTc-sestamibi after a first acute uncomplicated myocardial infarction treated with thrombolysis. Fifty patients who underwent revascularization within 90 d from the imaging studies were excluded. Cardiac death and nonfatal myocardial infarction were considered events. Follow-up was 98\% complete in a mean period of 44 {\textpm} 19 mo. Results: Myocardial ischemia was detectable in 55 (58\%) patients at SPECT and in 63 (67\%) patients at DSE. Concordance between SPECT and DSE in detecting ischemia was observed in 68 (72\%) of the 94 patients (κ value, 0.41). During the follow-up, there were 20 cardiac events (9 deaths and 11 nonfatal myocardial infarctions). Ischemia at SPECT was a significant predictor of events (hazards ratio = 4.8; 95\% confidence interval, 1.4{\textendash}16.3; P \< 0.01). However, ischemia at DSE (biphasic or worsening patterns) was not associated with events, whereas biphasic pattern alone was associated with a poor outcome compared with direct worsening (P \< 0.05). Finally, at Cox multivariate analysis, ischemia at SPECT but not biphasic pattern at DSE was a significant independent predictor of events (P \< 0.01). Conclusion: These results indicate that, after uncomplicated myocardial infarction, ischemia at SPECT is associated with an increased risk of cardiac events at long-term follow-up. However, ischemia at DSE was unable to stratify patients after myocardial infarction.}, issn = {0161-5505}, URL = {https://jnm.snmjournals.org/content/46/3/417}, eprint = {https://jnm.snmjournals.org/content/46/3/417.full.pdf}, journal = {Journal of Nuclear Medicine} }