Murray D P, Rafiqi E, Murray R G, Littler W A
Eur J Nucl Med. 1986;11(10):381-5. doi: 10.1007/BF00261401.
The ability of pre-discharge thallium Tl201 scintigraphy and radionuclide angiography (RNA) to predict subsequent cardiac events was investigated in 46 apparently low-risk survivors of a first acute myocardial infarction. All patients underwent selective coronary arteriography at 3 months post-discharge. At the time of the initial investigation, half were beta-blocked, and thereafter, all patients were given prophylactic beta-blockade. During a mean follow-up period of 12 +/- 4 months, 14 patients (30%) experienced cardiac events, i.e. recurrent myocardial infarction (3 patients), angina pectoris (13 patients) and coronary surgery (8 patients). No patient died during the follow-up period. Of the 14 with subsequent cardiac events, 11 were identified by the presence of a reversible perfusion defect at 201Tl scintigraphy, while 7 exhibited abnormal left ventricular exercise reserve on RNA. The predictive accuracy of 201Tl (85%) for subsequent cardiac events exceeded that of RNA (56%; P less than 0.01) and of arteriographic multi-vessel disease (65%; P less than 0.05). The sensitivity of the non-invasive techniques was not influenced by beta-blockade at the time of investigation. Thus, 201Tl scintigraphy appears to be the more accurate technique for the assessment of the prognosis of apparently low-risk patients following myocardial infarction. The accuracy of the technique was not reduced by beta-adrenergic blockade.
对46例首次急性心肌梗死的明显低危存活患者进行研究，以探讨出院前铊Tl201心肌闪烁显像和放射性核素血管造影（RNA）预测后续心脏事件的能力。所有患者在出院后3个月接受选择性冠状动脉造影。在初始检查时，一半患者接受了β受体阻滞剂治疗，此后，所有患者均接受预防性β受体阻滞剂治疗。在平均随访12±4个月期间，14例患者（30%）发生了心脏事件，即复发性心肌梗死（3例）、心绞痛（13例）和冠状动脉手术（8例）。随访期间无患者死亡。在14例发生后续心脏事件的患者中，11例通过Tl201心肌闪烁显像显示可逆性灌注缺损得以识别，而7例在RNA检查中显示左心室运动储备异常。Tl201对后续心脏事件的预测准确性（85%）超过了RNA（56%；P<0.01）和动脉造影多支血管病变（65%；P<0.05）。研究时，β受体阻滞剂对这些非侵入性技术的敏感性没有影响。因此，Tl201心肌闪烁显像似乎是评估心肌梗死后明显低危患者预后更准确的技术。β肾上腺素能阻滞剂并未降低该技术的准确性。
