Prognostic value of myocardial perfusion imaging with adenosine triphosphate

Background. Pharmacologic stress with scintigraphy can predict prognosis in patients with coronary disease. Adenosine triphosphate (ATP) has been used in stress testing, but its efficacy in assessing prognosis has not been studied. Methods and Results. A total of 150 patients (95 men, aged 64 +/- 10 years) were studied with thallium 201 during intravenous infusion of ATP and at rest. Perfusion defects were classified as reversible or mixed. The lung-heart ratio was calculated. During a maximum follow-up of 4.5 years, the following final events were considered: death, nonfatal myocardial infarction, angina or heart failure requiring hospitalization, or clinical need for myocardial revascularization. The prognostic value of different variables was analyzed with Cox regression. Groups with significantly worse prognosis were as follows: men, smokers, those with previous myocardial infarction, those with total cholesterol/high-density lipoprotein greater than 5, and those with lung-heart ratio greater than 0.5. Multivariate Cox regression showed the presence of perfusion defects as the only variable predictive of prognosis. It was time-dependent, with the highest risk at the beginning of follow-up. Mixed defects had the highest risk, followed by moderate to severe reversible defects. Conclusions. ATP with TI-201 gamma-tomography is useful in predicting prognosis of patients with coronary artery disease.