Dipyridamole-thallium-201 scintigraphy in the prediction of future cardiac events after acute myocardial infarction

• Published in: The New England journal of medicine Vol. 310; no. 16; p. 1014
• Main Authors: Leppo, J A, O'Brien, J, Rothendler, J A, Getchell, J D, Lee, V W
• Format: Journal Article
• Language: English
• Published: United States 19-04-1984
• Subjects: Aged; Angina Pectoris - etiology; Coronary Circulation; Dipyridamole; Exercise Test; Female; Follow-Up Studies; Heart - diagnostic imaging; Humans; Male; Middle Aged; Myocardial Infarction - diagnostic imaging; Prognosis; Radioisotopes; Radionuclide Imaging; Recurrence; Thallium
• ISSN: 0028-4793
• DOI: 10.1056/nejm198404193101603

To evaluate the safety and usefulness of serial thallium scanning immediately after intravenous dipyridamole, we studied 51 patients recovering from acute myocardial infarction. Eight patients experienced angina during the procedure, but there were no serious complications. Patients were followed for a mean period of 19 months after hospital discharge. Eleven of 12 patients who died during follow-up or had another infarction had shown transient defects (redistribution) on their predischarge scan, as had 22 of the 24 patients who needed readmission for management of angina. Among all the other clinical or scintigraphic criteria tested, the presence of redistribution on the dipyridamole-thallium scan was the only significant predictor of these serious cardiac events. Twenty-six patients were also given a submaximal exercise test before discharge, of whom 13 subsequently had serious cardiac events. The exercise test had been positive in only 6 of these 13 patients, whereas the dipyridamole-thallium scan had shown a redistribution pattern in 12 (P less than 0.001). We conclude from this preliminary study that dipyridamole-thallium scintigraphy after myocardial infraction is relatively safe. It appears to be a more sensitive predictor of subsequent cardiac events than a submaximal exercise test and may therefore prove useful in evaluating patients after recovery from a myocardial infarction.