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(Circulation. 1999;100:2392.)
© 1999 American Heart Association, Inc.

Brief Rapid Communications

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, MD; Peter B. Berger, MD; Michael K. O’Connor, PhD; David O. Hodge, MD; Raymond J. Gibbons, MD

From the Mayo Clinic and Mayo Foundation, Rochester, Minn.

Correspondence to Timothy F. Christian, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail christian.timothy{at}mayo.edu

Background—Quantitative measures of myocardial perfusion defect severity from acute ^99mTc-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 ^99mTc-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 ^99mTc-sestamibi defect can be used to predict whether infarction will develop despite successful reperfusion.

Key Words: myocardial infarction • blood flow • angioplasty • tomography

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