(Circulation. 1995;92:334-341.)
© 1995 American Heart Association, Inc.
Articles |
Infarct Size After Acute Myocardial Infarction Measured by Quantitative Tomographic 99mTc Sestamibi Imaging Predicts Subsequent Mortality
From the Divisions of Cardiovascular Diseases and Internal Medicine (T.D.M., T.F.C., M.R.H., B.J.G., R.J.G.) and Statistics and Health Sciences Research (D.O.H.), Mayo Clinic, Rochester, Minn; and the Cardiology Division (B.J.G.), Georgetown University Medical Center, Washington, DC.
Correspondence to Todd D. Miller, MD, East 16-A, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
Background 99mTc sestamibi is a recently developed radioisotope that has been used to measure myocardium at risk and infarct size. The relation between these measurements and subsequent patient outcome has not yet been demonstrated.
Methods and Results Two hundred seventy-four consecutive patients
with acute myocardial infarction underwent tomographic
99mTc sestamibi imaging on arrival at the hospital (to
measure myocardium at risk before reperfusion therapy) and
at hospital discharge (to measure the amount of salvaged
myocardium and final infarct size). Defect size on the
sestamibi images was quantified using a threshold value of 60% of peak
counts from the circumferential count profile curves generated for five
representative slices of the left ventricle. Patients
were followed after hospital discharge to evaluate the association
between final infarct size and subsequent mortality. The median defect
size measured was 27% of the left ventricle at
presentation to the hospital (range, 0% to 77%) and was
12% of the left ventricle at hospital discharge (range, 0% to 68%).
Almost one half of the patients had a final infarct size of 
10%. The
median amount of myocardium salvaged was 9% (range, -31%
to 75%). During a median duration of follow-up of 12 months, there
were 10 deaths (7 cardiac and 3 noncardiac) and 1 resuscitated
out-of-hospital cardiac arrest. There was a significant association
between infarct size and overall mortality
(
2=8.66, P=.003) and cardiac mortality
(2=11.89, P<.001). Two-year mortality
was 7% for patients whose infarct size was 
12% versus 0% for
patients whose infarct size was <12%. There also was a significant
association between myocardium at risk and cardiac
mortality (2=6.87, P=.009). There was
no association between myocardium at risk and overall
mortality or between amount of myocardium salvaged and
either overall mortality or cardiac mortality.
Conclusions Larger infarct size measured by 99mTc sestamibi imaging after acute myocardial infarction is associated with increased mortality risk during short-term follow-up.
Key Words: 99mTc sestamibi • imaging • myocardial infarction • mortality • prognosis
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