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Usefulness of early positive technetium-99m stannous pyrophosphate scan in predicting reperfusion after thrombolytic therapy for acute myocardial infarction

  • Dante E. Manyari
    Correspondence
    Address for reprints: Dante E. Manyari, MD, Cardiology Division, Foothills Hospital, 1403 29th Street, Northwest, Calgary, Canada T2N 2T9.
    Affiliations
    From the Divisions of Cardiology, Department of Medicine and Nuclear Medicine, Department of Radiological Sciences and Diagnostic Imaging, the University of Calgary, Calgary, Canada

    From the Cardiovascular Laboratories, Foothills Hospital, Calgary, Canada
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  • Christopher R. Thompson
    Affiliations
    From the Divisions of Cardiology, Department of Medicine and Nuclear Medicine, Department of Radiological Sciences and Diagnostic Imaging, the University of Calgary, Calgary, Canada

    From the Cardiovascular Laboratories, Foothills Hospital, Calgary, Canada
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  • Henry J. Duff
    Affiliations
    From the Divisions of Cardiology, Department of Medicine and Nuclear Medicine, Department of Radiological Sciences and Diagnostic Imaging, the University of Calgary, Calgary, Canada

    From the Cardiovascular Laboratories, Foothills Hospital, Calgary, Canada
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  • Merril L. Knudtson
    Affiliations
    From the Divisions of Cardiology, Department of Medicine and Nuclear Medicine, Department of Radiological Sciences and Diagnostic Imaging, the University of Calgary, Calgary, Canada

    From the Cardiovascular Laboratories, Foothills Hospital, Calgary, Canada
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  • Reinhard Kloiber
    Affiliations
    From the Divisions of Cardiology, Department of Medicine and Nuclear Medicine, Department of Radiological Sciences and Diagnostic Imaging, the University of Calgary, Calgary, Canada

    From the Cardiovascular Laboratories, Foothills Hospital, Calgary, Canada
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  • Eldon R. Smith
    Affiliations
    From the Divisions of Cardiology, Department of Medicine and Nuclear Medicine, Department of Radiological Sciences and Diagnostic Imaging, the University of Calgary, Calgary, Canada

    From the Cardiovascular Laboratories, Foothills Hospital, Calgary, Canada
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  • Israel Belenkie
    Affiliations
    From the Divisions of Cardiology, Department of Medicine and Nuclear Medicine, Department of Radiological Sciences and Diagnostic Imaging, the University of Calgary, Calgary, Canada

    From the Cardiovascular Laboratories, Foothills Hospital, Calgary, Canada
    Search for articles by this author
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      Abstract

      To test the hypothesis that scans with technetium-99m pyrophosphate (Tc-99m-PPi) are positive when performed early after successful thrombolytic therapy for acute myocardial infarction (AMI), 16 consecutive patients with AMI who received thrombolytic therapy within 5 hours after the onset of chest pain were studied. Patients were included if chest pain lasted for >30 minutes, was unresponsive to sublingual nitroglycerin and was associated with at least 0.2 mV ST-segment elevation in at least 2 contiguous electrocardiographic leads. All patients received 1.5 million IU of streptokinase intravenously, a mean of 195 ± 99 minutes after onset of chest pain. Tc-99m-PPi scans and coronary cineanglograms were recorded 491 ± 156 minutes and 518 ± 202 minutes, respectively, after the onset of symptoms. Effective reperfusion was present in 10 patients, 6 of whom had positive Tc-99m-PPi scans (sensitivity of 60% to detect reperfusion). Of the 6 patients without effective reperfusion, 3 had positive Tc-99m-PPi scans (specificity of 50%, p >0.05). Analysis of the data using various definitions of effective reperfusion or artery patency yielded similar results. Thus, our findings indicate that early AMI scanning with Tc-99m-PPi does not accurately detect the presence or absence of reperfusion in patients with AMI after treatment with intravenous streptokinase. At this time, coronary cineangiography is the only reliable method to detect reperfusion promptly after thrombolytic therapy.
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