Use of 99mTc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction.
OBJECTIVE
Preserved thrombolysis in myocardial infarction (TIMI) flow before percutaneous coronary intervention (PCI) in acute myocardial infarction is related to improved outcome. Gated single-photon emission computed tomography (SPECT) allows the simultaneous assessment of left ventricular perfusion and function. We evaluated the initial risk area and subsequent evolution of perfusion and function according to TIMI flow before successful primary PCI.


METHODS
In 36 patients, treated with abciximab, primary PCI and stenting, 99mTc-sestamibi was injected before PCI and gated SPECT acquired thereafter. Gated SPECT was repeated 7 and 30 days later. Perfusion defect, wall motion score index, left ventricular ejection fraction and volumes were examined.


RESULTS
Before PCI, 14 patients (group A) showed TIMI flow 2-3 and 22 (group B) TIMI flow 0-1, but no differences in clinical variables, initial risk area, wall motion score, ejection fraction or volumes. Perfusion defect was smaller in group A at 7 (9%+/-11% vs 19%+/-14%, p<0.02) and 30 days (7%+/-7% vs 16%+/-12%, p<0.02) and the salvage index was higher at 30 days (77%+/-22% vs 55%+/-28%, p<0.02). Wall motion score was lower in group A at 30 days (p<0.05). Ejection fraction significantly improved in both groups at 7 and 30 days. End-diastolic volume showed a trend towards a reduction in group A, whilst it was significantly increased in group B. Conversely, end-systolic volume was significantly decreased in group A but remained unchanged in group B.


CONCLUSIONS
In the setting of optimal myocardial reperfusion for myocardial infarction, preserved TIMI flow before PCI does not limit the initial risk area but it does improve myocardial salvage and functional recovery.
Leoncini
Mario
M
Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy.
Bellandi
Francesco
F
Sciagrà
Roberto
R
Maioli
Mauro
M
Toso
Anna
A
Sestini
Stelvio
S
Coppola
Angela
A
Mennuti
Alberto
A
Dabizzi
Roberto Piero
RP
Pupi
Alberto
A
D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D019275:Radiopharmaceuticals; D020127:Recovery of Function / Q000502:physiology; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods*; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi