title: Assessment of the area at risk after acute myocardial infarction using 123I-MIBG SPECT: Comparison with the angiographic APPROACH-score.
abstract: Assessment of the area at risk (AAR) associated with an acute myocardial infarction is crucial for evaluating prevention and revascularization strategies. The aim of this study was to evaluate whether123I-metaiodobenzylguanidine (123I-MIBG) single-photon emission computed tomography (SPECT) provides a more widely available assessment of anatomical AAR than the established anatomical angiographic methods.
  
  
  
  Seventy patients with ST-segment elevation acute myocardial infarction (STEMI) underwent coronary angiography with percutaneous coronary intervention and subsequent123I-MIBG myocardial scintigraphy with left myocardial relative radiotracer uptake evaluation 12 ± 10 days after STEMI. Patients were divided into two groups depending on whether the culprit artery was occluded (50 patients) or sub-occluded (20 patients). Two scores were calculated as a percentage of the left ventricular myocardium surface, the first using a standard 17-segment summed rest score derived from the relative quantitative evaluation of123I-MIBG myocardial uptake (MAR) and the second using the modified APPROACH-score (ApAR).
  
  
  
  For the patients with occluded artery, this study showed a high correlation between MAR and the angiographic score (Pearson r = .762 and P < .0001). For the patients with sub-occluded artery, for which the ApAR is not reliable, this study showed no correlation between MAR and the angiographic score (Pearson r = .18 and P = 0.45).
  
  
  
  123I-MIBG myocardial scintigraphy provides ARR assessment similar to that of ApAR in patients with a single occluded coronary artery. However, MAR differs from ApAR when angiographic scores are known to be inaccurate (sub-occluded culprit artery) or impossible to use. Further studies are needed to evaluate the potential clinical interest of123I-MIBG SPECT as an alternative for area at risk assessment after STEMI even when the culprit artery is sub-occluded or when the angiographic scores cannot be used.
authors.affiliation: Department of Nuclear Medicine, Montpellier University Hospital, 34295, Montpellier Cedex 5, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Vauchot
authors.affiliation: Department of Nuclear Medicine, Montpellier University Hospital, 34295, Montpellier Cedex 5, France.
authors.forename: Fayçal
authors.initials: F
authors.lastname: Ben Bouallègue
authors.affiliation: Department of Cardiology, Montpellier University Hospital, 34295, Montpellier Cedex 5, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Hedon
authors.affiliation: Department of Cardiology, Clinique du Millénaire, 34960, Montpellier Cedex 2, France.|IGF - UMR5203 - U1191 - UM, Montpellier, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Piot
authors.affiliation: Department of Cardiology, Montpellier University Hospital, 34295, Montpellier Cedex 5, France.|PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France.
authors.forename: François
authors.initials: F
authors.lastname: Roubille
authors.affiliation: Department of Nuclear Medicine, Montpellier University Hospital, 34295, Montpellier Cedex 5, France. d-mariano_goulart@chu-montpellier.fr.|PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France. d-mariano_goulart@chu-montpellier.fr.
authors.forename: Denis
authors.initials: D
authors.lastname: Mariano-Goulart
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D017023:Coronary Angiography; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D018570:Risk Assessment; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019797:3-Iodobenzylguanidine
keywords: 123I-MIBG SPECT; Myocardial infarction; area at risk; coronary angiography