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

• Published in: Circulation (New York, N.Y.) Vol. 94; no. 11; pp. 2735 - 2742
• Main Authors: Dakik, H A, Mahmarian, J J, Kimball, K T, Koutelou, M G, Medrano, R, Verani, M S
• Format: Journal Article
• Language: English
• Published: United States 01-12-1996
• Subjects: Aged; Coronary Angiography; Exercise; Exercise Test; Female; Heart Diseases; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - drug therapy; Myocardial Infarction - physiopathology; Prognosis; Risk Factors; Sensitivity and Specificity; Stroke Volume; Thallium Radioisotopes; Thrombolytic Therapy; Tomography, Emission-Computed, Single-Photon
• ISSN: 0009-7322

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 defect size (P = .005). The combination of ejection fraction and thallium tomography added significant incremental prognostic information to the clinical data, whereas angiography did not further improve a model that included clinical, ejection fraction, and tomographic variables.
Quantitative exercise 201Tl tomography provides important incremental, long-term prognostic information in patients receiving thrombolytic therapy for acute myocardial infarction.