Establishing an approach for patients with recent coronary occlusion: Identification of viable myocardium

Background. Revascularization of occluded coronary arteries after myocardia l infarction (MI) may restore flow to viable myocardium and improve ventric ular function, The aim of this pilot study waste determine the potential ut ility of thallium-201 viability imaging for the prediction of recovery of r egional ventricular function in patients undergoing revascularization of to tal or subtotal occlusion of infarct-related arteries (TIMI 0-2 flow) durin g the convalescent period after MI. Methods. Twenty-three patients were identified < 6 weeks after MI and under went Tl-201 viability imaging (rest imaging, n = 16; stress/reinjection ima ging, n = 7) and radionuclide angiography, Patients were revascularized wit h percutaneous transluminal coronary artery in 10, stent in 10, and bypass in 3, Follow-up radionuclide angiography at 3 months was used to assess rec overy of regional wall motion. Results, Among 41 abnormal wall motion segments in the infarct territories, the sensitivity, specificity, and accuracy for Tl-201 imaging in the predi ction of recovery of regional function were 89% (25/28), 54% (7/13), and 78 % (32/41), respectively. When 8 segments supplied by vessels with restenosi s to >70% were excluded, specificity improved to 70%, Wall motion scores im proved in those with adequate revascularization (1.6 +/- 1.4 vs 2.7 +/- 1.6 ; P < .001) but not in those with restenosis or occlusion (1.8 +/- 1.0 vs 2 .0 +/- 1.6; P = NS). Conclusions. In patients with an occluded artery after MI, Tl-201 viability imaging can detect recoverable myocardium with reasonable accuracy and may help select which patients will most benefit from revascularization.