Prognostic value of exercise 201Tl tomography in patients treated with thrombolytic therapy during acute myocardial infarction

Circulation
H A DakikM S Verani

Abstract

Although myocardial perfusion scintigraphy is of proven value in the risk stratification of patients with a recent myocardial infarction who receive conventional therapy, its value in patients undergoing thrombolytic therapy remains controversial. Seventy-one patients who received thrombolytic therapy for acute myocardial infarction had exercise 201Tl tomography and coronary angiography before hospital discharge. Eleven (15%) of 71 patients had ischemic ST-segment depression during exercise, whereas 27 patients (38%) had scintigraphic ischemia. Twenty-five (37%) of 68 patients had a cardiac event consisting of either death (n = 2), recurrent myocardial infarction (n = 5), congestive heart failure (n = 7), or unstable angina (n = 11) during a follow-up of 26 +/- 18 months. Univariate predictors of cardiac events were as follows: Killip class (P = .04); left ventricular ejection fraction (P < .0005); total (P = .002) and ischemic (P < .0005) perfusion defect size; percent thallium lung uptake (P = .001); presence of infarct-zone redistribution (P = .02); and multivessel coronary artery disease (P = .01). By multivariate analysis, the significant joint predictors of risk were ejection fraction (P < .0005) and ischemic perfusion de...Continue Reading

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