VALUE OF TL-201 IMAGING IN DETECTING ADVERSE CARDIAC EVENTS AFTER MYOCARDIAL-INFARCTION AND THROMBOLYSIS - A FOLLOW-UP OF 100 CONSECUTIVE PATIENTS

Objective-To determine the prognostic role of thallium-201 imaging com pared with that of exercise electrocardiography in patients with acute myocardial infarction treated by thrombolysis. Design-Patients who re mained free of adverse cardiac events six weeks after myocardial infar ction had stress and rest Tl-201 imaging and exercise electrocardiogra phy and were followed up for 8-32 months. Adverse cardiac events (deat h, reinfarction, unstable angina, and congestive heart failure) were d ocumented.Setting-Large district general hospital, Middlesex. Subjects -100 consecutive male and female patients who were stable six weeks af ter thrombolysis for myocardial infarction. Main outcome measures-Pred iction of occurrence of adverse cardiac events after myocardial infarc tion by exercise cardiography and Tl-201 myocardial perfusion imaging. Results-Reversible ischaemia on Tl-201 imaging predicted adverse card iac events in 33 out of 37 patients with such events during follow up (hazard ratio 8.1 (95% confidence interval 2.7 to 23.8), P<0.001). Exe rcise electrocardiography showed reversible ischaemia in 33 patients, of whom 13 had subsequent events, and failed to predict events in 24 p atients (hazard ratio 1.1 (0.56 to 2.2), P = 0.8). Conclusion-Tl-201 i maging is a sensitive predictor of subsequent adverse cardiac events i n patients who have received thrombolysis after acute myocardial infar ction, whereas exercise electrocardiography fails to predict outcome.