MYOCARDIAL SCINTIGRAPHY IN ACUTE MYOCARDIAL-INFARCTION TREATED WITH SYSTEMIC THROMBOLYSIS - HOW FAR ARE WE FROM OBTAINING RELIABLE INFORMATION FOR RESCUE PTCA

All noninvasive tests have an unsatisfactory accuracy in assessing pat ency of the infarct related vessel after systemic thrombolysis. In lar ge infarctions, the prompt knowledge of the amount of jeopardized myoc ardium, as well as the eventual success of thrombolysis on the culprit lesion are major clinical needs in the subsequent decision making pro cess, including the indication no rescue PTCA. Several reasons preclud e a meaningful use of thallium scintigraphy in this setting: the most important one is the need to perform pre-thrombolytic images before th e administration of the active agent, implying a delay in the administ ration of thrombolysis that is clinically not acceptable. SestaMIBI pe rfusion scintigraphy at rest seems more suitable in this regard. Sesta MIBI practically does not redistribute in the myocardium, and this imp lies that after an administration at admission in the CCU, the pre-thr ombolysis images can be aquired later, without any interference with t he therapeutic schedule. 'The estimate of myocardial salvage can be ob tained by the comparison of the perfusion pattern derived from a later sestaMIBI injection with the pre-lysis :images. Both planar and tomog raphic reconstructions have satisfactory positive and negative predict ive accuracy for the patency of the culprit vessel. Difficulties are r elated with the necessity of having this information timely; we descri be a few protocols, appeared in the literature, that might contribute in solving such problems. SestaMIBI imaging in patients with acute myo cardial infarction should be encouraged and extended, given its potent ial to represent one of the best tool to judge the amount of jeopardiz ed myocardium, the obtained salvage, and to guide the decision making after systemic thrombolysis. (C) 1998 Elsevier Science Ireland Ltd.