Abstract | OBJECTIVES: The purpose of this study was to determine whether gated adenosine Tc-99m sestamibi single-photon emission computed tomography (ADSPECT) could accurately define risk and thereby guide therapeutic decision making in stable survivors of acute myocardial infarction (AMI). BACKGROUND: Controversy continues as to the role of noninvasive stress imaging in stratifying risk early after AMI. METHODS: The INSPIRE ( Adenosine Sestamibi Post- Infarction Evaluation) trial is a prospective multicenter trial which enrolled 728 clinically stable survivors of AMI who had gated ADSPECT within 10 days of hospital admission and subsequent 1-year follow-up. Event rates were assessed within prospectively defined INSPIRE risk groups based on the adenosine-induced left ventricular perfusion defect size, extent of ischemia, and ejection fraction. RESULTS: Total cardiac events/death and reinfarction significantly increased within each INSPIRE risk group from low (5.4%, 1.8%), to intermediate (14%, 9.2%), to high (18.6%, 11.6%) (p < 0.01). Event rates at 1 year were lowest in patients with the smallest perfusion defects but progressively increased when defect size exceeded 20% (p < 0.0001). The perfusion results significantly improved risk stratification beyond that provided by clinical and ejection fraction variables. The low-risk INSPIRE group, comprising one-third of all enrolled patients, had a shorter hospital stay with lower associated costs compared with the higher-risk groups (p < 0.001). CONCLUSIONS: Gated ADSPECT performed early after AMI can accurately identify a sizeable low-risk group who have a <2% death and reinfarction rate at 1 year. Identifying these low-risk patients for early hospital discharge may improve utilization of health care resources at considerable cost savings.
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Authors | John J Mahmarian, Leslee J Shaw, Neil G Filipchuk, Habib A Dakik, Sherif S Iskander, Terrence D Ruddy, Milena J Henzlova, Felix Keng, Adel Allam, Lemuel A Moyé, Craig M Pratt, INSPIRE Investigators |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 48
Issue 12
Pg. 2448-57
(Dec 19 2006)
ISSN: 1558-3597 [Electronic] United States |
PMID | 17174181
(Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Chemical References |
- Radiopharmaceuticals
- Technetium Tc 99m Sestamibi
- Adenosine
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Topics |
- Adenosine
- Aged
- Female
- Humans
- Male
- Middle Aged
- Myocardial Infarction
(diagnostic imaging)
- Patient Discharge
- Prospective Studies
- Radiopharmaceuticals
- Risk Assessment
- Technetium Tc 99m Sestamibi
- Tomography, Emission-Computed, Single-Photon
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