Post-myocardial infarction risk stratification with stress nuclear myocardial perfusion imaging versus echocardiography: Separate but not equal

The unique contribution of the study by Candell-Riera et al in this issue of the Journal is the evaluation of the prognostic value of stress nuclear MPI and stress echocardiography in the same post-MI cohort. Importantly, it confirms the valuable information that stress nuclear MPI has to offer for management of post-MI patients and simultaneously underscores the limitations of stress echocardiography for the same application. Although the study has limitations, including its relatively small sample size, these observations are consistent with those of a large body of literature involving thousands of patients. Thus this study supports the use of stress nuclear MPI for the evaluation of the post-MI patient as part of an evidence-based clinical practice and provides further concern regarding the use of stress echocardiography as an alternative imaging modality in this setting. It should serve as a reminder that when it comes to evaluation of the patient with coronary heart disease, not all noninvasive tests are created equal.