title: Prognostic value of exercise 201Tl tomography in patients treated with thrombolytic therapy during acute myocardial infarction.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Tex, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Dakik
authors.forename: J J
authors.initials: JJ
authors.lastname: Mahmarian
authors.forename: K T
authors.initials: KT
authors.lastname: Kimball
authors.forename: M G
authors.initials: MG
authors.lastname: Koutelou
authors.forename: R
authors.initials: R
authors.lastname: Medrano
authors.forename: M S
authors.initials: MS
authors.lastname: Verani
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006331:Heart Diseases; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013794:Thallium Radioisotopes; D015912:Thrombolytic Therapy; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013794:Thallium Radioisotopes