The Journal of Thoracic and Cardiovascular Surgery, Vol 87, 27-34, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Intracoronary thallium 201 scintigraphy as an immediate predictor of salvaged myocardium following intracoronary lysis
HJ Krebber, J Schofer, D Mathey, R Montz, P Kalmar and G Rodewald
Since February of 1980, 157 patients who had had symptoms of acute
myocardial infarction for less than 3 hours underwent intracoronary lysis.
Forty-six patients required early aorta-coronary revascularization.
However, operation was believed to be indicated only when intracoronary
lysis was successful and myocardium was salvaged. Since left ventricular
angiography proved unreliable in assessing the viability of the myocardium
in the acute stage, starting in March of 1981 we obtained intracoronary
thallium 201 scintiscans in 23 patients before and after intracoronary
lysis. Patients in whom there was a significant reduction (greater than
50%) in the initial 201Th defect (n = 12) were considered ideal candidates
for operation (Group 3). Patients with poor or unimproved 201Th uptake
after successful intracoronary lysis (n = 6) were treated medically (Group
2), as were patients in whom intracoronary lysis was unsuccessful (n = 5,
Group 1). In order to validate this new approach, we compared the change in
the regional wall motion of the "infarcted area," as shown in the early and
follow-up left ventricular angiograms in all three groups. In the acute
stage, the mean regional ejection fraction was 19.9% in Group 1, 19.1% in
Group 2, and 20.1% in Group 3. Only in Group 3 was there a significant
increase in regional ejection fraction to a mean of 51%. The mean ejection
fraction obtained at follow-up in Groups 1 and 2 was 16.5% and 17.3%,
respectively. From our findings, we conclude that 201Th scintigraphy is a
valuable predictor of the salvageability of myocardium immediately
following intracoronary lysis. To date, it has been the most valuable tool
in assessing those patients suitable for early coronary revascularization.
