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Summary Objective: Previous investigations on the prognostic value of myocardial perfusion imaging (MPI) were performed under circumstances in which the test result was known to the patient's physician. We wanted to examine the prognostic value of MPI in patients with known or suspected stable angina in a setting in which MPI could not influence the diagnostic and therapeutic strategy. Design: A prospective series of 507 patients referred to coronary angiography for this condition were examined by MPI before angiography. Management was based on symptoms and angiographic findings, as the results of MPI were not communicated. Patients were followed for a mean of 45·3 ± 7·7 months. Results: During follow-up, 20 patients (3·9%) suffered from myocardial infarction, 19 (3·8%) died and eight (1·6%) were revascularized >1 year after MPI resulting in a combined annual event rate of 2·5%. Patients with normal MPI had a low annual event rate of 1·6% (or 1·1% with regard to myocardial infarction or death only). In contrast, event rates in patients with reversible or mixed ischaemia were 4·0% per year. MPI added independent prognostic value to standard clinical data in a multivariate Cox model. Conclusion: We could confirm that in patients with known or suspected stable angina, MPI is a valuable risk stratifying tool.

Summary Objective: To assess reproducibility and validity of clinical classification of angina pectoris (AP) patients. Design: Fifty-six patients scheduled for coronary angiography because of stable AP were classified by two independent observers with regard to (i) type and (ii) severity of chest pain (Canadian Cardiovascular Society, CCS) and (iii) cardiac functional status (New York Heart Association, NYHA). Myocardial perfusion imaging (MPI) was performed in 55 including measurement of ejection fraction in 46, angiography was undertaken in 51. Results: Observers agreed 100% on the presence (n = 45) or absence (n = 11) of angina. They agreed in 52 (93%), 48 (86%), and 42 (75%) patients with regard to type of pain, CCS grade, and NYHA class, respectively. In the remaining patients, they disagreed by one class only. The positive and negative predictive values of typical/atypical angina for perfusion abnormalities and coronary disease were 55%/82% and 53%/82%, respectively. Conclusions: Observer agreement was excellent for presence, type, and severity of chest pain but moderate with regard NYHA class. Clinical judgment could not predict with reasonable accuracy abnormal perfusion or coronary artery disease.