Journal of the American College of Cardiology
Post-Infarction Myocardial Perfusion Imaging
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, Leslee J. Shaw, Neil G. Filipchuk, Habib A. Dakik, Sherif S. Iskander, Terrence D. Ruddy, Milena J. Henzlova, Felix Keng, Adel Allam, Lemuel A. Moyé, Craig M. Pratt and INSPIRE Investigators
Table 3
Table 3
Overall Baseline Clinical and Scintigraphic Characteristics of the Study Population and Differences Across INSPIRE Risk Groups
| All Patients (n = 728) | Low (n = 242) | Intermediate (n = 213) | High (n = 68) | Randomized (n = 205) | p Value | |
|---|---|---|---|---|---|---|
| Age (yrs) | 63 ± 12 | 63 ± 12 | 63 ± 12 | 64 ± 12 | 64 ± 12 | 0.69 |
| Female gender | 31% | 42% | 28% | 25% | 24% | <0.0001 |
| Race | 0.007 | |||||
| African | 10% | 15% | 11% | 10% | 5% | |
| Hispanic | 5% | 3% | 8% | 9% | 4% | |
| Asian | 6% | 5% | 8% | 1% | 6% | |
| Caucasian | 75% | 75% | 71% | 80% | 82% | |
| Other | 4% | 2% | 2% | 0% | 3% | |
| Heart rate (beats/min) | 75 ± 15 | 74 ± 14 | 74 ± 25 | 82 ± 16 | 77 ± 51 | 0.19 |
| Hypertension (BP ≥140/90 mm Hg) | 58% | 62% | 53% | 64% | 57% | 0.16 |
| Diabetes | 30% | 23% | 36% | 41% | 28% | 0.006 |
| Family history of CAD | 27% | 27% | 27% | 26% | 27% | 0.9 |
| Hyperlipidemia | 62% | 60% | 60% | 73% | 65% | 0.15 |
| Total cholesterol | 205 ± 56 | 207 ± 51 | 203 ± 72 | 202 ± 47 | 206 ± 42 | 0.82 |
| LDL cholesterol | 115 ± 45 | 118 ± 49 | 112 ± 46 | 114 ± 46 | 113 ± 40 | 0.82 |
| HDL cholesterol | 42 ± 14 | 42 ± 12 | 43 ± 20 | 40 ± 12 | 41 ± 11 | 0.45 |
| Triglycerides | 175 ± 145 | 177 ± 145 | 155 ± 139 | 174 ± 142 | 193 ± 150 | 0.07 |
| Smoking history | 58% | 59% | 58% | 68% | 55% | 0.29 |
| Prior CAD | 28% | 20% | 31% | 51% | 28% | <0.0001 |
| Prior AMI | 17% | 9% | 21% | 30% | 18% | <0.0001 |
| Killip class | <0.0001 | |||||
| I | 70% | 89% | 60% | 44% | 66% | |
| II | 18% | 10% | 34% | 25% | 10% | |
| III–IV | 12% | 1% | 6% | 31% | 23% | |
| Peak creatine kinase | 960 ± 1,032 | 652 ± 612 | 1,423 ± 1,390 | 1,110 ± 1,069 | 781 ± 765 | <0.0001 |
| Peak creatine kinase-MB | 68 ± 96 | 46 ± 62 | 87 ± 119 | 96 ± 122 | 61 ± 83 | <0.0001 |
| Peak troponin T | 6.2 ± 42 | 1.1 ± 1 | 19.7 ± 81 | 4.4 ± 7 | 1.4 ± 3 | 0.14 |
| Peak troponin I | 28.3 ± 56 | 22.7 ± 37 | 39.2 ± 71 | 29.4 ± 74 | 22.5 ± 50 | 0.19 |
| STEAMI | 60% | 53% | 74% | 66% | 50% | <0.0001 |
| Q-wave AMI | 48% | 39% | 63% | 57% | 42% | <0.0001 |
| AMI location | <0.0001 | |||||
| Anterior | 32% | 22% | 46% | 52% | 22% | |
| Inferior | 38% | 44% | 34% | 19% | 43% | |
| Lateral | 10% | 10% | 7% | 13% | 13% | |
| Posterior | 2% | 2% | 4% | 0% | 2% | |
| Other | 18% | 23% | 8% | 16% | 20% | |
| Thrombolytic therapy | 35% | 32% | 45% | 25% | 30% | 0.002 |
| Thrombolytic therapy for STEAMI | 58% | 61% | 59% | 38% | 60% | 0.006 |
| TIMI risk score | 0.006 | |||||
| Low (0–2) | 57% | 62% | 57% | 62% | 50% | |
| Intermediate (3–5) | 35% | 33% | 36% | 31% | 38% | |
| High (≥6) | 8% | 5% | 8% | 7% | 12% | |
| Total PDS (%) | 26.3 ± 17 | 7.4 ± 6 | 36.1 ± 13 | 44.2 ± 12 | 32.6 ± 10 | <0.0001 |
| Scar PDS (%) | 16.1 ± 15 | 4.6 ± 5 | 32.3 ± 13 | 20.5 ± 20 | 11.3 ± 11 | <0.0001 |
| Ischemia PDS (%) | 10.2 ± 11 | 2.8 ± 3 | 3.7 ± 3 | 23.7 ± 12 | 21.3 ± 9 | <0.0001 |
| LVEF (%) | 46 ± 14 | 57 ± 12 | 37 ± 13 | 28 ± 8 | 48 ± 9 | <0.0001 |
Values expressed as mean ± standard deviation or percentage.
AMI = acute myocardial infarction; BP = blood pressure; CAD = coronary artery disease; HDL = high-density lipoprotein; INSPIRE = Adenosine Sestamibi SPECT Post-Infarction Evaluation trial; LDL = low-density lipoprotein; LVEF = left ventricular ejection fraction; PDS = perfusion defect size; STEAMI = ST-segment elevation acute myocardial infarction; TIMI = Thrombolysis In Myocardial Infarction.
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