Recently some Authors observed a low sensitivity of submaximal exercise thallium-201 myocardial scintigraphy for predicting multivessel coronary disease in patients with recent acute myocardial infarction (AMI) treated with thrombolytic therapy. The aim of our study was to evaluate the accuracy of dipyridamole thallium-201 single photon emission computerized tomography (DIP-SPECT) for predicting the location and the extent of coronary artery disease in patients with recent uncomplicated AMI and to compare the results obtained in patients treated with thrombolytic therapy (Group T) to those obtained in patients treated with non-thrombolytic therapy (Group NT). We examined 61 consecutive patients with recent uncomplicated AMI by predischarge DIP-SPECT as well as by coronary angiography. In the Group T the total number of reversible perfusion defects per patient was 2.6 +/- 1.9 of which 2.1 +/- 1.6 at infarct site and 0.5 +/- 0.7 in other coronary territories; similarly, in the Group NT the total number of reversible perfusion defects per patient was 2.5 +/- 1.6 (NS compared to Group T) of which 1.9 +/- 1.2 (NS compared to Group T) at infarct site and 0.5 +/- 0.8 (NS compared to Group T) in other coronary territories. In Group T, DIP-SPECT demonstrated a sensitivity of 84% with specificity of 60% for predicting critical (> or = 70%) stenoses at infarct site as well as a sensitivity of 54% with specificity of 54% in the other coronary territories (data are expressed in number of patients per cent). The sensitivity and specificity observed in Group NT did not differ significantly from those of Group T.(ABSTRACT TRUNCATED AT 250 WORDS)