Threshold values for preserved viability with a noninvasive measurement of collateral blood flow during acute myocardial infarction treated by direct coronary angioplasty

Timothy F. Christian, Peter B. Berger, Michael K. O'Connor, David O. Hodge, Raymond J. Gibbons

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Background - Quantitative measures of myocardial perfusion defect severity from acute (99m)Tc-sestamibi tomographic images (nadir) have correlated closely with collateral and residual antegrade blood flow during acute myocardial infarction. The purpose of this study was to determine whether a viability threshold could be identified from this measure in patients with acute myocardial infarction treated in a homogeneous manner with successful reperfusion therapy. Methods and Results - The study group consisted of 61 patients with acute myocardial infarction with a risk area of >6% LV treated with primary angioplasty between 120 and 240 minutes after symptom onset. All patients were injected with 20 to 30 mCi of (99m)Tc- sestamibi before primary angioplasty and imaged after the procedure. Acute myocardium at risk (MAR) and subsequent infarct size (IS) were quantified by a threshold program. Severity (nadir) from the acute image was the lowest ratio of minimal/maximum counts from 5 short-axis slices. Infarct location was anterior in 22 and inferior in 39 patients. MAR was 33±15% LV and IS was 13±15% LV: 23 patients had no infarction despite MAR similar to those with infarction. Receiver-operator characteristic curve analysis identified a nadir value of 0.26 as providing the best separation of patients with and without infarction (sensitivity, 74%; specificity, 74%). This nadir threshold varied by infarct location: anterior defect, 0.21; inferior defect, 0.31. The sensitivity and specificity for absent infarction for these values were anterior, 69% and 67%, and inferior, 88% and 84%, respectively. Conclusions - In a time frame in which the presence of residual blood flow is important, the severity of the acute (99m)Tc-sestamibi defect can be used to predict whether infarction will develop despite successful reperfusion.

Original languageEnglish (US)
Pages (from-to)2392-2395
Number of pages4
JournalCirculation
Volume100
Issue number24
DOIs
StatePublished - Dec 14 1999

Keywords

  • Angioplasty
  • Blood flow
  • Myocardial infarction
  • Tomography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Threshold values for preserved viability with a noninvasive measurement of collateral blood flow during acute myocardial infarction treated by direct coronary angioplasty'. Together they form a unique fingerprint.

  • Cite this