Open AccessPrediction of in‐hospital cardiac events using dipyridamole‐thallium scintigraphy performed very early after acute myocardial infarction
Author(s) -
Bosch Xavier,
Magriñá Jordi,
March Remei,
Sanz GinéS,
García Alicia,
Betriu Amadeo,
NavarroLópez Francisco
Publication year - 1996
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960190311
Subject(s) - medicine , dipyridamole , cardiology , myocardial infarction , scintigraphy , revascularization , thallium , aminophylline , perfusion , ischemia , inorganic chemistry , chemistry
Background and Hypothesis: Ischemic complications occur frequently during hospitalization after acute myocardial infarction. Dipyridamole‐thallium scintigraphy performed early after admission can detect residual ischemia, may have additional prognostic value and be useful in the management of these patients. Methods: Dipyridamole infusion and 201 thallium imaging were performed on the third day of infarction in 114 consecutive patients. Coronary angiography was performed before hospital discharge in 90% of patients and exercise testing was performed at the time of discharge in patients without contraindications. Results: Side effects occurred in 28 patients, but they were mild and transient or rapidly reversed with intravenous aminophylline. During hospitalization, three patients died and four had a nonfatal reinfarction. Patients with these major cardiac events had previously shown a higher prevalence of reversible perfusion defects during testing (71 vs. 31 %, p < 0.05). In addition, 19 patients had early recurrent ischemia requiring early in‐hospital revascularization. Overall, cardiac events defined as death, reinfarction, or early myocardial revascularization occurred in 22 patients. Of the patients with these events, 68% had thallium redistribution on initial myocardial scanning compared with 25% of patients without events (p = 0.0001). Patients with cardiac events also showed a higher number of myocardial segments with reversible perfusion defects (1.8 ± 2.2 vs. 0.6 ± 1.3, p = 0.001). Logistic regression analysis revealed that among all the other clinical, scintigraphic, and an‐giographic variables, the presence of thallium redistribution on the dipyridamole‐thallium scan was the only independent predictor of cardiac events, increasing the risk by sixfold. Furthermore, during a 1‐year follow‐up, 14 other patients had ischemic events. Of these, 64% had previously shown thallium redistribution during early dipyridamole testing compared with 19% of patients without cardiac events (p < 0.001). Conclusions: Intravenous dipyridamole‐thallium‐scintigraphy performed very early after myocardial infarction is safe and useful to predict in‐hospital ischemic events.