Prognostic Value of Dipyridamole Sestamibi Single-Photon Emission Computed Tomography and Dipyridamole Stress Echocardiography for New Cardiac Events After an Uncomplicated Myocardial Infarction Marc E. R. M. van Daele, MD,' Albert J. McNeill, MD,b Paolo M. Fioretti, MD, Alessandro Salustri, MD, a Massimo M.A. Pozzoli, MD,' El-Said M. El-Said, MD,d Ambroos E. M. Reijs, MSc, Edward 0. McFalls, MD, Ton Slagboom, MD, and Jos R. T. C. Roelandt, MD, FACC, Rotterdam, The Netherlands A high-dose dipyridamole stress test (0.84 mg/kg in 6 minutes) with simultaneous sestamibi single-photon emission computed tomographic (SPECT) and echocardiographic imaging was performed in 89 patients before hospital discharge after an uncomplicated myocardial infarction. The aim of this study was to determine the prognostic value of these tests for new cardiac events and to compare the relative values of SPECT and echocardiography in a postinfarction dipyridamole stress test. Two years after infarction, nine patients (10%) had died, five patients (6%) had suffered a nonfatal reinfarction, and 14 patients (16%) had been readmitted to the hospital for a revascularization procedure. Cardiac death had occurred in 5 (10%) of 48 patients with a positive SPECT versus 4 (10%) of 41 with a negative SPECT (difference not significant) and in 6 (19%) of 31 with a positive echocardiogram versus 3 (5%) of 56 with a negative echocardiogram (p = 0.05). Cardiac death or reinfarction had occurred in 8 (17%) of 48 patients with a positive SPECT versus 6 (15%) of 41 with a negative SPECT (difference not significant) and in 6 (19%) of 31 with a positive echocardiogram versus 8 (14%) of 56 with a negative echocardiogram (difference not significant). Thus the predictive value of.the dipyridamole stress test for new cardiac events after an uncomplicated myocardial infarction was limited, irrespective of the method used to detect ischemia. Reversible perfusion defects were identified more frequently than new wall motion abnormalities but did not predict late events. A positive dipyridamole echocardiogram was associated with a higher late mortality rate but did not predict other cardiac events. (J AM Soc EcHOCARDIOGR 1994;7:370-80.) The indication for coronary angiography 1 • 2 in pa- tients after an uncomplicated myocardial infarction (no signs of heart failure, postinfarction ischemia, or late ventricular arrhythmias) remains controversial. Ideally, noninvasive methods should be reliable for risk stratification and selection of the patients who need further invasive investigation and therapy. Myo- cardial ischemia during stress may identify patients at risk, and the value and limitations of postinfarc- tion exercise testing have been documented exten- sively. 3 " 10 However, many of these patients are unable to perform an adequate level of exercise, and the sensitivity of electrocardiographic ST segment changes has limitations. From the Division of Cardiology, Thoraxcenter, University Hos- pital Rotterdam-Dijkzigt, and Erasmus University. >Supported by the Interuniversity Cardiology Instirute of The Netherlands. bSuppotted by the British Heart Foundation. 'Supported by Fondazione Clinica del Lavoro, Pavia, Italy. rlSuppotted by the Al-Azhar University, Cairo, Egypt. Reprint requests: Marc E. R. M. van Dade, MD, Thoraxcenter Ba 302, Dr Molewaterplein 40, 3015 GD Rotterdam, The Neth- erlands. Copyright © 1994 by the American Society ofEchocardiography. 0894-7317/94$3.00 + 0 27/l/54208 370 Pharmacologic stress combined with either echo- cardiographic or nuclear imaging is highly reliable for the detection of ischemic heart disease, n- 18 but the value of these tests for risk stratification after an uncomplicated myocardial infarction remains unclear despite previous studies. 19 · 23