Elsevier

Journal of Nuclear Cardiology

Volume 11, Issue 4, July–August 2004, Pages 458-469
Journal of Nuclear Cardiology

Original article
Adenosine sestamibi SPECT post-infarction evaluation (INSPIRE) trial: A randomized, prospective multicenter trial evaluating the role of adenosine Tc-99m sestamibi SPECT for assessing risk and therapeutic outcomes in survivors of acute myocardial infarction

https://doi.org/10.1016/j.nuclcard.2004.05.003Get rights and content

Abstract

Background

Preliminary studies indicate that adenosine myocardial perfusion single photon tomography (SPECT) can safely and accurately stratify patients into low and high risk groups early after acute myocardial infarction (AMI).

Methods and results

INSPIRE is a prospective, randomized multicenter trial which enrolled 728 clinically stable survivors of AMI. Following baseline adenosine sestamibi gated SPECT, patients were classified as low, intermediate or high risk based on the quantified total and ischemic left ventricular (LV) perfusion defect size (PDS). A subset of high risk patients with a LV ejection fraction ≥35% were randomized to a strategy of either intensive medical therapy or coronary revascularization. Adenosine SPECT was repeated at 6-8 weeks to determine the relative effects of anti-ischemic therapies on total and ischemic PDS (primary endpoint). All patients were followed for one year. The baseline demographic, clinical and scintigraphic characteristics of the study population are presented. Adenosine SPECT was performed within 1 day of admission in 12% of patients and in 64% by Day 4.

Conclusion

The unique study design features of INSPIRE will further clarify the role of adenosine sestamibi SPECT in defining initial patient risk after AMI and in monitoring the benefits of intensive anti-ischemic therapies.

Section snippets

Methods

The organizational structure of the INSPIRE trial, including principal investigators and coinvestigators at participating centers and by-center recruitment, is contained in Appendix 1. A graphic representation of the INSPIRE study design is depicted in Figure 1. Over a 36-month period (December 1999 through December 2002), 728 patients were enrolled at 16 sites, with a 1-year subsequent follow-up.

Results

The results presented are limited to the baseline demographic, clinical, and scintigraphic characteristics of the 728 patients enrolled in the INSPIRE trial according to their risk group (Table 2) and the timing of adenosine SPECT imaging after hospital admission (Figure 3). The P values in Table 2 refer to a comparison across the four designated risk groups (ie, low, intermediate, high, and randomized).

The mean age across all groups was 63 years, with approximately one third of patients being

Discussion

The INSPIRE trial was designed to further define the potential role of quantitative adenosine Tc-99m sestamibi SPECT regarding two critical aspects of patient management after AMI: (1) risk stratification and (2) assessment of subsequent therapy. The INSPIRE study design included numerous features that were innovative and unique when compared with previous published trials.14, 33, 34

Acknowledgements

The authors have indicated they have no financial conflicts of interest.

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