Primary angioplasty in myocardial infarction: assessment of improved myocardial perfusion with technetium-99m isonitrile

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.

Technetium-99m-hexakis-2-methoxy-2-isobutyl-isonitrile (technetium-99m isonitrile) is a new radiopharmaceutical compound that reflects myocardial perfusion. Its kinetics, especially its lack of redistribution after intravenous administration, permits the assessment of changes in myocardial perfusion without delay of therapy. Tomographic images at rest were obtained immediately and 6 to 10 days later in 17 consecutive patients undergoing successful primary angioplasty during their first transmural myocardial infarction. Thirteen patients had anterior infarction. The initial (acute) defect size before angioplasty of 48 +/- 17% of the left ventricle decreased significantly (p less than 0.0001) to 29 +/- 19% on the late scans. There was no correlation between the time to therapy and the reduction in defect size. Twelve of the 17 patients, including 7 of the 11 patients treated after 4 h, demonstrated a definite reduction in the initial defect size. Eight patients with angiographically proved persistent coronary occlusion underwent a similar imaging sequence. The initial defect size in this group remained unchanged on the late scans (24 +/- 16% versus 26 +/- 18%, p = NS). Primary angioplasty is an effective approach toward salvaging myocardium; comparison with thrombolytic drug therapy must await the results of controlled clinical trials.

This article has been cited by other articles:

				R. J. Gibbons Tc-99m SPECT Sestamibi for the Measurement of Infarct Size Journal of Cardiovascular Pharmacology and Therapeutics, September 1, 2011; 16(3-4): 321 - 331. [Abstract] [PDF]

				G. W. Stone, J. L. Martin, M.-J. de Boer, M. Margheri, E. Bramucci, J. C. Blankenship, D. C. Metzger, R. J. Gibbons, B. S. Lindsay, B. H. Weiner, et al. Effect of Supersaturated Oxygen Delivery on Infarct Size After Percutaneous Coronary Intervention in Acute Myocardial Infarction Circ Cardiovasc Interv, October 1, 2009; 2(5): 366 - 375. [Abstract] [Full Text] [PDF]

				R. J. Gibbons, U. S. Valeti, P. A. Araoz, and A. S. Jaffe The quantification of infarct size J. Am. Coll. Cardiol., October 19, 2004; 44(8): 1533 - 1542. [Abstract] [Full Text] [PDF]

				R. Sciagra, S. Sestini, L. Bolognese, G. Cerisano, P. Buonamici, and A. Pupi Comparison of Dobutamine Echocardiography and 99mTc-Sestamibi Tomography for Prediction of Left Ventricular Ejection Fraction Outcome After Acute Myocardial Infarction Treated with Successful Primary Coronary Angioplasty J. Nucl. Med., January 1, 2002; 43(1): 8 - 14. [Abstract] [Full Text] [PDF]

				R. J. Gibbons, T. D. Miller, and T. F. Christian Infarct Size Measured by Single Photon Emission Computed Tomographic Imaging With 99mTc-Sestamibi : A Measure of the Efficacy of Therapy in Acute Myocardial Infarction Circulation, January 4, 2000; 101(1): 101 - 108. [Abstract] [Full Text] [PDF]

				G. L. Schaer, L. J. Spaccavento, K. F. Browne, K. A. Krueger, D. Krichbaum, J. M. Phelan, W. O. Fletcher, C. L. Grines, S. Edwards, M. K. Jolly, et al. Beneficial Effects of RheothRx Injection in Patients Receiving Thrombolytic Therapy for Acute Myocardial Infarction: Results of a Randomized, Double-Blind, Placebo-Controlled Trial Circulation, August 1, 1996; 94(3): 298 - 307. [Abstract] [Full Text]

				V. Sansoy, D. K. Glover, D. D. Watson, M. Ruiz, W. H. Smith, J. P. Simanis, and G. A. Beller Comparison of Thallium-201 Resting Redistribution With Technetium-99m Sestamibi Uptake and Functional Response to Dobutamine for Assessment of Myocardial Viability Circulation, August 15, 1995; 92(4): 994 - 1004. [Abstract] [Full Text]

				T. D. Miller, T. F. Christian, M. R. Hopfenspirger, D. O. Hodge, B. J. Gersh, and R. J. Gibbons Infarct Size After Acute Myocardial Infarction Measured by Quantitative Tomographic 99mTc Sestamibi Imaging Predicts Subsequent Mortality Circulation, August 1, 1995; 92(3): 334 - 341. [Abstract] [Full Text]