Diagnosis and management of acute myocardial infarction.

Nuclear cardiology offers techniques for assessing cardiac perfusion and function that provide useful information for diagnosing and managing acute myocardial infarction (MI). In particular, myocardial perfusion imaging provides important data on infarct size and myocardial viability that can help determine the best treatment strategies for patients with acute MI. First-pass or blood pool radionuclide angiographic assessment of ventricular ejection fraction remains an important prognostic indicator in acute MI, regardless of whether thrombolytic therapy is used. Comparative studies of radiotracer techniques and coronary angiography show that myocardial perfusion and ejection fraction can predict the risk of future cardiac events reliably in patients with acute MI, whereas the anatomic data provided by coronary angiography (e.g., degree of stenosis and presence of multivessel disease) have little prognostic value. Managed-care organizations could reduce costs and improve patient outcomes by relying more on nuclear cardiology and less on angiography in the management of patients' with acute MI.