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The aim of this prospective study was to compare the long-term prognostic value of myocardial contrast echocardiography (MCE) and single-photon emission computed tomography (SPECT) in patients undergoing diagnostic work-up for stable coronary artery disease (CAD).Methods: 103 patients (65 male, mean age 58±9) with suspected or known stable CAD underwent SPECT and accelerated high-dose dipyridamole (0.84mg/kg iv over 4 minutes)-atropine (up to 1mg iv) stress real-time MCE. Perfusion defects on MCE were visually assessed by consensus of 2 investigators. The presence of CAD was detected by coronary angiography performed in all patients regardless of SPECT and MCE results. All pts completed prospective follow-up regarding major adverse cardiovascular events (MACE: cardiac mortality, revascularization, infarction and unstable angina) for a period ranging from 1 to 67 months (median 30 months). The prognostic value of inducible perfusion defects detected by MCE and SPECT was then compared.Results: CAD defined as ≥70% stenosis was detected by coronary angiography in 77% of patients. During follow-up MACE occurred in 54 (52%) patients. The presence of inducible perfusion defects in SPECT was associated with high risk of MACE (HR: 2.5, 95%CI: 1.36-4.01, p<0.0001). However, cardiovascular complications were best predicted by the presence of inducible perfusion defects in stress MCE (HR: 6.7, 95%CI: 3.50-10.98, p<0.0001). The positive and negative predictive values for prediction of MACE by SPECT vs stress MCE were: 65.1% and 67,5% vs 75.4% and 81.0%, respectively.Conclusions: Positive stress MCE result is associated with higher risk of major adverse cardiovascular events than positive SPECT result in patients with suspected or known CAD in long-term follow-up.