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European Heart Journal 1995 16(7):909-913;
Copyright © 1995 by the European Society of Cardiology.
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© 1995 The European Society of Cardiology

Impact of immediate and delayed myocardial scintigraphy on therapeutic decisions in suspected acute myocardial infarction

E. KJØLLER, S. L. NIELSEN*, J. CARLSEN, F. NIELSEN, J. T. MØLIER*, K. HVID-JACOBSEN*, P. F. JENSEN*, K. SKAGEN and I.-L. KANSTRUP*

Department of Internal Medicine, Section of Cardiology University of Copenhagen, Denmark
*Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital University of Copenhagen, Denmark

revised 10 October 1994; accepted 28 October 1994.

Correspondence: Dr S. L. Nielsen, 54P1, Herlev Hospital, DK-2730, Herlev, Denmark.

Abstract

Early myocardial scintigraphic imaging has become technically feasible in patients admitted to hospital with suspected acute myocardial infarction. After prompt injection of 99mTc-sestamibi, subsequent scintigraphic imaging of perfused myocardium can be performed. During a 5-month period, 237 patients were admitted to the coronary care unit of a district hospital on suspicion of acute ischaemic syndrome, and injection of 99mTc-sestamibi for the performance of myocardial scintigraphy was carried out in 134 patients, on average 2 h after onset of symptoms. The investigation was repeated in 126 patients, on average 18 h after the injection. Three planar views were taken in the coronary care unit with a mobile gamma camera.

The prevalence of acute myocardial infarction was 53%. The predictive value at the first scintigraphic imaging for a positive or negative test for myocardial infarction 54% and 56%, respectively. Even exclusion of patients with a previous infarction did not increase the diagnostic validity. The predictive value of a negative test, 77%, at the second scintigraphy was still insufficient to make immediate therapeutic decisions. Myocardial scintigraphy performed early, on suspicion of acute myocardial infarction, cannot therefore be used routinely as a diagnostic test prior to intervention in unselected patients because some 90% of this patient group have myocardial perfusion defects.

Key Words: Myocardial infarction • scintigraphy • 99mTc-sestamibi • acute ischaemic syndrome


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