Thrombolytic therapy for myocardial infarction: Assessment of efficacy by myocardial perfusion imaging with technetium-99m sestamibi |
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| Affiliation: | 1. Royal Air Force Centre of Aviation Medicine, RAF Henlow, Bedfordshire SG16 6DN, UK;2. Division of Anaesthesia, Department of Medicine, University of Cambridge, Box 93, Addenbrooke''s Hospital, Cambridge CB2 2QQ, UK;3. Civil Aviation Authority, Gatwick Airport South, Aviation House, Crawley, Gatwick RH6 0YR, UK;4. University College London Hospital, 235 Euston Road, Bloomsbury, London NW1 2BU, UK;1. Department of Pharmacy, Saroj Institute of Technology & Management, Lucknow, Uttar Pradesh, India;2. Molecular Biology Division, National Institute of Malarial Research (NIMR), Dwarka, Delhi, India;3. Faculty of Pharmacy, Philadelphia University, Amman, Jordan;4. Mahaveer College of Pharmacy, Meerut, Uttar Pradesh, India;5. National Institute of Pharmaceutical Education and Research (NIPER)-Ahmedabad, Gandhinagar, Gujarat, India;1. Department of Pharmacology and Drug Analysis, Gustave Roussy Cancer Campus Grand Paris, Université Paris-Sud, Villejuif, France;2. Northern Institute for Cancer Research, Medical School, Newcastle University, Newcastle upon Tyne, UK;3. Unité fonctionnelle de Pharmacocinétique et Pharmacochimie, Hôpital Cochin, Paris, France;4. Service de Pharmacie clinique, Hôpital Cochin, Paris, France;5. Service de Pharmacie, Hôpital Hautepierre, Strasbourg, France;6. Division of Clinical Pharmacology, University Hospital Center and University of Lausanne, Lausanne, Switzerland;7. Pharmacie des Hôpitaux de l''Est Lémanique, Vevey, Switzerland;8. Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Stotervaart Hospital, Amsterdam, The Netherlands;9. Department of Pharmacy, CNRS-UMR 7054, School of Medicine Paris 12, Henri Mondor University Hospitals, Créteil, France;10. EA4553 Institut Claudius-Regaud, Université Paul-Sabatier, Toulouse, France;1. Division of Cardiovascular Medicine, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908, USA;2. Department of Radiology and Medical Imaging, Cardiovascular Imaging Center, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908, USA |
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| Abstract: | Technetium-99m (Tc-99m) sestamibi has been used to evaluate the efficacy of thrombolytic therapy. Improved image quality due to the higher photon energy of Tc-99m and the increased allowable doses of this radiopharmaceutical along with its lack of redistribution makes Tc-99m sestamibi an acceptable imaging agent for such studies. This imaging agent was used for serial quantitative planar and tomographic imaging to assess the initial risk area of infarction, its change over time and the relation to infarct-related artery patency in patients with a first acute myocardial infarction. Twenty-three of 30 patients were treated with recombinant tissue-type plasminogen activator (rt-PA) within 4 hours after onset of acute chest pain. Seven patients were treated in the conventional manner and did not receive thrombolytic therapy. The initial area at risk varied greatly both in patients treated with rt-PA and in those who received conventional therapy. Patients with successful thrombolysis and patent infarct arteries had a significantly greater reduction of Tc-99m sestamibi defect size than patients who had persistent coronary occlusion. Serial imaging with Tc-99m sestamibi could find important application in future clinical research evaluating the efficacy of new thrombolytic agents. Direct measurements of the amount of hypoperfused myocardium before and after thrombolysis could provide rapid and unequivocal results using fewer patients and avoiding the use of “mortality” as an end point. This approach has not yet been widely tested in the clinical arena. |
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