Comparison in acute myocardial infarction of anisoylated plasminogen streptokinase activator complex versus heparin evaluated by simultaneous thallium-201/technetium-99m pyrophosphate tomography.
In a subgroup of 45 patients with acute myocardial infarction (AMI) from the German multicenter trial of anisoylated plasminogen streptokinase activator complex (APSAC) (n = 20) versus heparin (n = 25), simultaneous thallium (TI)-201 technetium (Tc)-99m pyrophosphate (PYP) tomography was initiated to elucidate a possible benefit of APSAC over heparin. Findings in the 2 treatment groups were similar with respect to TI-201 defect score, relative scintigraphic infarct size, and in keeping with the main group coronary artery patency, global ejection fraction and maximal creatine kinase level. However, 2 different TI-201/Tc-99m PYP accumulation patterns within the area of infarction (homogeneous, group A; inhomogeneous, group B) were identified. Both treatment groups were similar with regard to the frequency of the homogeneous and inhomogeneous pattern. In comparing the 2 accumulation patterns, creatine kinase peaked earlier in group A than in group B, and global left ventricular ejection fraction was significantly higher in group A than in group B. In Group A, 30 of 31 patients and in group B 7 of 11 patients had a patent infarct-related vessel (p < 0.025). TI-201 defect score was lower in group A than in group B. Likewise, relative size of the infarction as determined from Tc-99m PYP images was significantly lower in group A than in group B. Fifteen patients experienced cardiogenic shock or severe heart failure. Patients in group B had a higher incidence of these in-hospital complications than patients in group A (92 vs 12%, p < 0.0005). Scintigraphic infarct size and TI-201 defect score were greater in patients with the aforementioned clinical events.(ABSTRACT TRUNCATED AT 250 WORDS)
Krause
T
T
Albert-Ludwigs-Universität, Radiologische Universitätsklinik, Abteilung Nuklearmedizin, Freiburg, Germany.
Kasper
W
W
Meinertz
T
T
Schnitzler
M
M
Just
H
H
Schümichen
C
C
Moser
E
E
D016255:Anistreplase / Q000627:therapeutic use*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D013318:Stroke Volume / Q000502:physiology; D016698:Technetium Tc 99m Pyrophosphate; D013794:Thallium Radioisotopes; D015912:Thrombolytic Therapy; D014055:Tomography, Emission-Computed; D014654:Vascular Patency; D016277:Ventricular Function, Left / Q000502:physiology
D013794:Thallium Radioisotopes; D016698:Technetium Tc 99m Pyrophosphate; D016255:Anistreplase; D006493:Heparin; D003402:Creatine Kinase