Effect of primary coronary angioplasty on left ventricular function and myocardial perfusion as determined by Tc-99m sestamibi scintigraphy☆

There is little information available regarding the changes in the size of acute myocardial infarction (AMI) and the evolution of left ventricular (LV) function over time after primary angioplasty. 1 The evaluation of these parameters could give additional insight into the mechanisms of myocardial recovery and the possible additional benefits of adjunctive therapy to primary angioplasty. The size of the AMI can be quantified by using single-photon emission computed tomographic imaging (SPECT) scintigraphy with technetium-99m (Tc-99m) sestamibi. 2‐ 4 In this study, we evaluated the changes in LV function and in the size of the AMI with SPECT scintigraphy in patients with AMI treated with primary angioplasty. To accomplish this, SPECT was performed at the time of admission, at 72 hours, and at 3 months after primary angioplasty. ••• We studied 24 consecutive patients with AMI who were admitted to the emergency room at our institution, in whom primary angioplasty was indicated. A signed informed consent was obtained in all cases. Diagnosis of AMI was based on the classic criteria of chest pain and ST-segment elevation $ 1m m in$2 contiguous electrocardiographic leads. We studied patients with a first AMI who came to the emergency room within 6 hours of the onset of chest pain. Patients with prior infarction, cardiogenic shock, and those in whom coronary angiography revealed patency of the infarct-related artery (Thrombolysis In Myocardial Infarction 3 flow) were excluded. Primary angioplasty was considered to be successful when grade 3 Thrombolysis In Myocardial Infarction flow was obtained with a residual stenosis ,30%. All patients were given aspirin, and those who had stent implantation received ticlopidine or clopidogrel. Intravenous heparin in a bolus of 10,000 IU was given before angioplasty, with subsequent dosing as needed to maintain an activated coagulation time of about 300 seconds. Before primary angioplasty and during the chest