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Unlike dipyridamole testing with thallium-201, the ability of technetium-99m sestamibi (MIBI) myocardial imaging to evaluate risk of later cardiac events has not been established. In this study, the prognostic value of dipyridamole MIBI myocardial tomography (same-day, rest-stress protocol) was assessed in 534 patients with stablle chest pain consistent with angina pectoris. During follow-up (mean 13 + or - 5 months), 58 patients (11%) had a major cardiac event--nonfatal myocardial infarction (n = 14) or cardiac death (n = 44). A history of congestive heart failure, prior myocardial infarction or diabetes mellitus, and either a reversible or fixed myocardial perfusion defect on MIBI scans were univariate and multivariate predictors of increased cardiac risk. Cardiac events occurred in 2% of patients with normal MIBI scans, compared with 15% with abnormal scan,s 17% with reversible perfusion defects and 16% with fixed defects (all p

The Asymptomatic Cardiac Ischemia Pilot (ACIP) and modified ACIP treadmill exercise protocols were developed to test patients with coronary artery disease and to linearly increase work load between stages. The physiologic changes that occurred with ACIP and modified ACIP were compared to those with the Bruce and Cornell protocols in 28 normal subjects and 16 men with coronary artery disease. The exercise protocols were randomly assigned over 2 days, and gas exchange data were obtained continuously with each test. In normal subjects, the peak heart rate, systolic blood pressure, peak oxygen consumption rate ([VO.sub.2]) and minute ventilation were similar for the 4 protocols tested, with exercise time shortest for the Bruce protocol in comparison with the ACIP, modified ACIP and Cornell protocols (10.2 [+ or -] 3.1 vs 13.4 [+ or -] 4.9, 13.9 [+ or -] 4.5, and 15.0 [+ or -] 4.2 minutes, respectively; p