title: Myocardial perfusion scintigraphy (SPECT) during adenosine stress can be performed safely early on after thrombolytic therapy in acute myocardial infarction.
abstract: The objective of this study was to evaluate the safety of myocardial perfusion scintigraphy with Tc-99 m sestamibi during adenosine stress in patients with recent thrombolytically treated myocardial infarction. Eighty-four patients with thrombolytically treated myocardial infarction, 59 males and 25 females, aged 62.9 +/- 8.4, were eligible for myocardial perfusion scintigraphy during adenosine provocation. Exclusion criteria for adenosine stress were hypotension, unstable angina pectoris, cardiac failure, pericarditis and atrioventricular block (AV block) II-III. Adenosine-stress and resting myocardial perfusion scintigraphy was performed 2-5 days after thrombolysis. Scintigraphy at rest was done 24 h after the stress study. Sixty patients (71%) experienced some kind of side-effects during adenosine infusion. The most frequent side-effects were dyspnoea in 43/84 patients (51%) and unspecific chest discomfort in 26/84 patients (31%). During infusion, ST depressions or elevations on ECG were seen in 9 patients (11%), 5 of whom experienced atypical chest discomfort. Five patients (6%) described typical angina but none of them showed electrographic signs of myocardial ischaemia during infusion. Six patients (7%) developed transient AV block I-II. Reversible scintigraphic perfusion defects were seen in 67 patients (79%). No serious complications, such as death, reinfarction or severe arrhythmias, occurred during adenosine infusion or during a 3-day clinical follow-up period. In conclusion, MIBI-SPECT during adenosine stress is a safe diagnostic method that can be performed in most patients early on after thrombolytically treated acute myocardial infarction. Side-effects are common but benign, and not different from those seen in patients with chronic coronary artery disease.
authors.affiliation: Department of Clinical Physiology, Söder Hospital, Karolinska Institute, Stockholm, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Bouvier
authors.forename: J
authors.initials: J
authors.lastname: Höjer
authors.forename: J
authors.initials: J
authors.lastname: Hulting
authors.forename: H
authors.initials: H
authors.lastname: Ruiz
authors.forename: B
authors.initials: B
authors.lastname: Samad
authors.forename: M
authors.initials: M
authors.lastname: Jensen-Urstad
mesh_terms: D000241:Adenosine / Q000009:adverse effects; D000368:Aged; D004417:Dyspnea / Q000139:chemically induced; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006327:Heart Block / Q000139:chemically induced; D006339:Heart Rate; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D017256:Technetium Tc 99m Sestamibi; D015912:Thrombolytic Therapy; D015899:Tomography, Emission-Computed, Single-Photon / Q000592:standards*
chemical_list: D017256:Technetium Tc 99m Sestamibi; D000241:Adenosine