[Myocardial perfusion with 201-thallium tomography in the post-infarct phase: prognostic significance and 1-year follow-up].

An individualized post-infarction risk stratification has impact on therapeutic decision making and prognosis after acute myocardial infarction. For evaluation of the cardiac risk profile 80 consecutive post-infarction patients were subjected to biphasic thallium-201 tomography after dipyridamole infusion for maximal coronary vasodilation. By correlating the extent and localization of reversible and irreversible perfusion defects with coronary angiography and one-year follow-up data of 94% of the patients, several univariate parameters with prognostic implications for a risk profile were identified. A stepwise logistic regression model selected the combination of 1) an irreversible defect of greater than 30% of left ventricular myocardium with less than 25% redistribution in the total defect, and 2) a reversible defect of greater than 6% of myocardium with 25% redistribution in the total defect to give optimal sensitivity of 100% and a specificity of 97% for cardiac events such as recurrence of angina, reinfarction, interventional coronary revascularization, and death within one year post infarction. Thus, the semiquantitative tomographic analysis of post-infarction myocardial perfusion allows an efficient individual risk stratification with a non-invasive technique.