J Am Coll Cardiol, 2006; 48:2448-2457, doi:10.1016/j.jacc.2006.07.069 (Published online 28 November 2006). © 2006 by the American College of Cardiology Foundation

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (19) Citing Articles via Google Scholar Google Scholar Articles by Mahmarian, J. J. Search for Related Content PubMed Articles by Mahmarian, J. J. Related Collections Related Article

A Multinational Study to Establish the Value of Early Adenosine Technetium-99m Sestamibi Myocardial Perfusion Imaging in Identifying a Low-Risk Group for Early Hospital Discharge After Acute Myocardial Infarction

John J. Mahmarian, MD, FACC^_*,1,_*, Leslee J. Shaw, PhD^,2, Neil G. Filipchuk, MD^,3, Habib A. Dakik, MD, Sherif S. Iskander, MD^||,4, Terrence D. Ruddy, MD^¶, Milena J. Henzlova, MD^#,4, Felix Keng, MD^_**, Adel Allam, MD, Lemuel A. Moyé, MD, PhD, Craig M. Pratt, MD, FACC^_* for the INSPIRE Investigators

^_* Methodist DeBakey Heart Center, Department of Cardiology, The Methodist Hospital, Houston, Texas
Cedars-Sinai Medical Center, Los Angeles, California
University of Calgary, Calgary, Alberta, Canada
American University of Beirut, Beirut, Lebanon
^|| Cardiovascular Associates of East Texas, Tyler, Texas
^¶ University of Ottawa Heart Institute, Ottawa, Ontario, Canada
^# Mount Sinai Medical Center, New York, New York
^_** National Heart Centre, Singapore, Singapore
Al-Azhar University, Cairo, Egypt
University of Texas School of Public Health, Houston, Texas.

View larger version (49K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Days from hospital admission to adenosine imaging for patients enrolled at United States (USA) versus non-USA sites.

View larger version (66K): [in this window] [in a new window] [Download PPT slide]   Figure 2 The INSPIRE study design. IPDS = ischemic perfusion defect size; LVEF = left ventricular ejection fraction; SPECT = single-photon emission computed tomography.

View larger version (22K): [in this window] [in a new window] [Download PPT slide]   Figure 3 Total (A) and cardiac death/reinfarction (B) rates based on INSPIRE risk categories.

View larger version (17K): [in this window] [in a new window] [Download PPT slide]   Figure 4 Predicted 1-year total and death/reinfarction event rates (with standard error bars) based on total (A) and ischemic (B) perfusion defect size (PDS) and their combination (C). The isobars in C (range 10% to 75%) depict risk for any event. For a patient with a 30% nonischemic PDS, the predicted event rate is 11% (solid circle), versus 25% if the defect is all ischemic (open circle). LV = left ventricle.

View larger version (44K): [in this window] [in a new window] [Download PPT slide]   Figure 5 The incremental prognostic value of scintigraphic variables compared with TIMI risk score. Abbreviations as in Figure 2.

View larger version (28K): [in this window] [in a new window] [Download PPT slide]   Figure 6 Predicted event rates (95% confidence intervals) in low, intermediate, and high INSPIRE risk groups in selected subpopulations. MI = myocardial infarction. *p < 0.0001 for low risk versus intermediate, high risk; p = 0.039 for low risk versus intermediate, high risk.