Incremental predictive value of myocardial scintigraphy with 123I-BMIPP in patients with acute myocardial infarction treated with primary percutaneous coronary intervention.
OBJECTIVE
It is unclear whether 123I-labelled beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP) myocardial scintigraphy adds further predictive value for future cardiac events compared with the variables obtained during cardiac catheterisation in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI). We therefore investigated whether 123I-BMIPP imaging in patients with AMI treated by primary PCI was useful in predicting future cardiac events.


METHODS
One hundred and fifty-nine patients with AMI who were treated with primary PCI and underwent left ventriculography (LVG) on admission underwent 201Tl and 123I-BMIPP myocardial scintigraphy. Scintigrams were visually classified, and the total defect score (TDS) was calculated. Major adverse cardiac events (MACE) were defined as cardiac death including sudden death, congestive heart failure and recurrence of acute coronary syndrome. Patients were followed up for a mean of 34.5 months (12-63 months).


RESULTS
Twenty-six patients had MACE. Kaplan-Meier analysis indicated that patients with the top 50% of 123I-BMIPP TDSs had a significantly higher rate of MACE (P=0.007). Patients with mismatch between 201Tl and 123I-BMIPP images also had significantly more MACE (P=0.02). In the prediction of MACE, the global chi-square value was 5.2 (P=0.001) based on LVEF (<45%) and the number of diseased vessels (two or three). Adding 123I-BMIPP TDS and the mismatch improved the global chi-square value (chi2=7.2)


CONCLUSIONS
Myocardial scintigraphy using 201Tl and 123I-BMIPP predicts future cardiac events in patients with AMI treated with primary PCI, and provides additional predictive value compared with the variables obtained with cardiac catheterisation alone.
Nanasato
Mamoru
M
Cardiovascular Center, Nagoya Daini Red Cross Hospital, 2-9 Myouken-cho, Showa, Nagoya, 466-8650 Japan. nana@nagoya2.jrc.or.jp
Hirayama
Haruo
H
Ando
Akitada
A
Isobe
Satoshi
S
Nonokawa
Makoto
M
Kinoshita
Yoshimi
Y
Nanbu
Ichiro
I
Yokota
Mitsuhiro
M
Murohara
Toyoaki
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D005227:Fatty Acids; D005260:Female; D006801:Humans; D007462:Iodobenzenes; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate; D013793:Thallium; D016896:Treatment Outcome
D005227:Fatty Acids; D007462:Iodobenzenes; D019275:Radiopharmaceuticals; C049338:iodofiltic acid; C027549:thallium chloride; D013793:Thallium