This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sutton, J. M. Articles by Topol, E. J. Search for Related Content PubMed PubMed Citation Articles by Sutton, J. M. Articles by Topol, E. J.

Circulation, Vol 83, 1278-1286, Copyright © 1991 by American Heart Association

ARTICLES

Significance of a negative exercise thallium test in the presence of a critical residual stenosis after thrombolysis for acute myocardial infarction

JM Sutton and EJ Topol
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.

BACKGROUND. After thrombolytic therapy for acute myocardial infarction, increasing emphasis is placed on early submaximal exercise testing, with further intervention advocated only for demonstrable ischemia. Although significant residual coronary artery lesions after successful thrombolysis are common, many patients paradoxically have no corresponding provokable ischemia. METHODS AND RESULTS. The relation between significant postthrombolytic residual coronary artery disease and a negative early, submaximal exercise thallium-201 tomogram was studied among 101 consecutive patients with uncomplicated myocardial infarction and at least 70% residual stenosis of the infarct artery. A negative test occurred in 49 (48.5%) patients with a mean 88% residual infarct artery stenosis. Further characteristics of the group were as follows: mean time to treatment was 3.1 hours; mean age was 54 +/- 10 years; 80% were male; 47% had anterior infarction; 39% had multivessel disease; mean left ventricular ejection fraction was 53 +/- 14%; and mean peak creatine kinase level was 3,820 +/- 3,123 IU/ml. A similar group of 52 (51.5%) patients, treated within 3.3 hours from symptom onset, with a mean postthrombolysis stenosis of 90%, had a positive exercise test. Characteristics of this group were as follows: age was 58 +/- 10 years; 92% were male; 56% had anterior infarction; 40% had multivessel disease; and mean left ventricular ejection fraction was 54 +/- 15%. The peak creatine kinase level associated with the infarction, however, was lower: 2,605 +/- 1,805 IU/ml (p = 0.04). There was no difference in performance at exercise testing with respect to peak systolic pressure, peak heart rate, or time tolerated on the treadmill between the two groups. By multivariate logistic regression, only peak creatine kinase level predicted a negative stress result in the presence of a significant residual stenosis (odds ratio, 4.2; 95% confidence interval, 1.1-16.3). CONCLUSIONS. The explanation for the relatively frequent finding of a negative early stress 201Tl tomogram after apparently successful reperfusion appears to be more extensive myocardial necrosis and not delay in therapy or inadequate exercise performance.

This article has been cited by other articles:

				M. Previtali, R. Fetiveau, L. Lanzarini, C. Cavalotti, and C. Klersy Prognostic value of myocardial viability and ischemia detected by dobutamine stress echocardiography early after acute myocardial infarction treated with thrombolysis J. Am. Coll. Cardiol., August 1, 1998; 32(2): 380 - 386. [Abstract] [Full Text] [PDF]

				E. J. Topol and S. E. Nissen Our Preoccupation With Coronary Luminology : The Dissociation Between Clinical and Angiographic Findings in Ischemic Heart Disease Circulation, October 15, 1995; 92(8): 2333 - 2342. [Abstract] [Full Text]

				B. L. Zaret and F. J. Wackers Nuclear Cardiology- First of Two Parts N. Engl. J. Med., September 9, 1993; 329(11): 775 - 783. [Full Text]