MYOCARDIAL PERFUSION SCINTIGRAPHY (SPECT) DURING ADENOSINE STRESS CANBE PERFORMED SAFELY EARLY ON AFTER THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL-INFARCTION

The objective of this study was to evaluate the safety of myocardial p erfusion scintigraphy with Tc-99 m sestamibi during adenosine stress i n patients with recent thrombolytically treated myocardial infarction. Eighty-four patients with thrombolytically treated myocardial infarct ion, 59 males and 25 females, aged 62.9 +/- 8.4, were eligible for myo cardial perfusion scintigraphy during adenosine provocation. Exclusion criteria for adenosine stress were hypotension, unstable angina pecto ris, cardiac failure, pericarditis and atrioventricular block (AV bloc k) II-III. Adenosine-stress and resting myocardial perfusion scintigra phy was performed 2-5 days after thrombolysis. Scintigraphy at rest wa s done 24 h after the stress study. Sixty patients (71%) experienced s ome kind of side-effects during adenosine infusion. The most frequent side-effects were dyspnoea in 43/84 patients (51%) and unspecific ches t discomfort in 26/84 patients (31%). During infusion, ST depressions or elevations on ECG were seen in 9 patients (11%), 5 of whom experien ced atypical chest discomfort. Five patients (6%) described typical an gina but none of them showed electrographic signs of myocardial ischae mia during infusion. Six patients (7%) developed transient AV block I- LI. Reversible scintigraphic perfusion defects were seen in 67 patient s (79%). No serious complications, such as death, reinfarction or seve re arrhythmias, occurred during adenosine infusion or during a 3-day c linical follow-up period. In conclusion, MIBI-SPECT during adenosine t ress is a safe diagnostic method that can be performed in most patient s early on after thrombolytically treated acute myocardial infarction. Side-effects are common but benign, and not different from those seer in patients with chronic coronary artery disease.