Prognostic investigations after myocardial infarction: a comparison of radionuclide angiography and 201Tl scintigraphy.

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.