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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^_*,_*, Leslee J. Shaw, PhD, Neil G. Filipchuk, MD, Habib A. Dakik, MD, Sherif S. Iskander, MD^||, Terrence D. Ruddy, MD^¶, Milena J. Henzlova, MD^#, 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, TexasUSA
Cedars-Sinai Medical Center, Los Angeles, CaliforniaUSA
University of Calgary, Calgary, Alberta, Canada
American University of Beirut, Beirut, Lebanon
^|| Cardiovascular Associates of East Texas, Tyler, TexasUSA
^¶ University of Ottawa Heart Institute, Ottawa, Ontario, Canada
^# Mount Sinai Medical Center, New York, New YorkUSA
^_** National Heart Centre, Singapore, Singapore
Al-Azhar University, Cairo, Egypt
University of Texas School of Public Health, Houston, TexasUSA

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.