Reverse redistribution on thallium-201 single-photon emission tomography after primary angioplasty: a one-year follow-up study

The prognostic significance of reverse redistribution (RR) on thallium-201 single-photon emission tomography (SPET) images after acute myocardial infa rction (AMI) has not been studied in detail. Moreover, RR data in patients treated with primary angioplasty are lacking. Fifty consecutive patients (i ncluding 40 men with a mean age of 54+/-11 years) with a first AMI were tre ated with primary angioplasty and followed up for 13+/-5 months for the fol lowing end-points: death, reinfarction and recurrent angina requiring revas cularisation. Admission and peak creatine kinase myocardial enzyme (CKMB) a nd ejection fraction (EF) at discharge were studied as markers of myocardia l damage. Thallium-201 stress-redistribution SPET studies at I month were a nalysed using a 13-segment, 4-point scoring system. Segments showing a wors ening of perfusion by at least 1 point on redistribution studies were defin ed as showing RR. RR was present in 13 (26%) patients (group 1) and absent in 37 (74%) (group 2). Both groups were comparable for age, sex, peak CKMB release, EF and Q-wave myocardial infarctions. TIMI flow 3 was obtained in 92% in group 1 and 95% in group 2 (P = 0.95). On admission, CKMB was signif icantly lower in group:roup I (18+/-14 vs 44+/-41 U/1, P = 0.03). Also, seg ments showing reversible perfusion were significantly more frequent in grou p 2 (1/169 vs 57/481, P = 0.01). During follow-up, no death occurred and th e combined documented end point of reinfarction and recurrent angina requir ing angioplasty or coronary artery bypass grafting was significantly more f requently reached in group 2 (0/13 vs 10/37, P = 0.046). In conclusion, RR is common (26%) after primary angioplasty for a first AMI and is associated with lesser myocardial damage on admission. Patients with RR rarely have r eversible segments on (201)T1 SPET and tend to have a favourable outcome af ter 1 year of follow-up.