Document Detail

Prognostic value of exercise 201Tl tomography in patients treated with thrombolytic therapy during acute myocardial infarction.
MedLine Citation:
PMID:  8941097     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSIONS: Quantitative exercise 201Tl tomography provides important incremental, long-term prognostic information in patients receiving thrombolytic therapy for acute myocardial infarction.
H A Dakik; J J Mahmarian; K T Kimball; M G Koutelou; R Medrano; M S Verani
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  94     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1996 Dec 
Date Detail:
Created Date:  1997-01-02     Completed Date:  1997-01-02     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2735-42     Citation Subset:  AIM; IM    
Department of Medicine, Baylor College of Medicine, Houston, Tex, USA.
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MeSH Terms
Coronary Angiography
Exercise Test
Heart Diseases
Middle Aged
Multivariate Analysis
Myocardial Infarction / drug therapy*,  physiopathology,  radiography*
Risk Factors
Sensitivity and Specificity
Stroke Volume
Thallium Radioisotopes / diagnostic use*
Thrombolytic Therapy*
Tomography, Emission-Computed, Single-Photon*
Reg. No./Substance:
0/Thallium Radioisotopes

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