Prognostic value of dipyridamole technetium-99m sestamibi myocardial tomography in patients with stable chest pain who are unable to exercise

Am J Cardiol. 1994 Apr 1;73(9):647-52. doi: 10.1016/0002-9149(94)90927-x.


Unlike dipyridamole testing with thallium-201, the ability of technetium-99m sestamibi (MIBI) myocardial imaging to evaluate risk of later cardiac events has not been established. In this study, the prognostic value of dipyridamole MIBI myocardial tomography (same-day, rest-stress protocol) was assessed in 534 patients with stable chest pain consistent with angina pectoris. During follow-up (mean 13 +/- 5 months), 58 patients (11%) had a major cardiac event--nonfatal myocardial infarction (n = 14) or cardiac death (n = 44). A history of congestive heart failure, prior myocardial infarction or diabetes mellitus, and either a reversible or fixed myocardial perfusion defect on MIBI scans were univariate and multivariate predictors of increased cardiac risk. Cardiac events occurred in 2% of patients with normal MIBI scans, compared with 15% with abnormal scans, 17% with reversible perfusion defects and 16% with fixed defects (all p < 0.01). Relative risks (univariate Cox analysis) associated with an abnormal MIBI scan, a reversible perfusion defect and a fixed defect were 8.4 (95% confidence interval [CI] 2.6 to 26.8), 1.9 (95% CI 1.1 to 3.2) and 2.4 (95% CI 1.4 to 4.3), respectively. Patients with any kind of perfusion abnormality (reversible or fixed) had a significantly lower cardiac event-free survival than those with normal scans (all p < 0.0001). It is concluded that, as with thallium-201 myocardial scintigraphy, a normal MIBI scan is associated with low cardiac risk, whereas dipyridamole-induced myocardial perfusion defects identify patients with significantly increased risk.

MeSH terms

  • Aged
  • Angina Pectoris / diagnostic imaging*
  • Dipyridamole*
  • Exercise
  • Female
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Rest
  • Risk Factors
  • Survival Analysis
  • Technetium Tc 99m Sestamibi*
  • Tomography, Emission-Computed, Single-Photon* / methods


  • Dipyridamole
  • Technetium Tc 99m Sestamibi