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Value of Myocardial Defect Size Measured by Thallium-201 SPECT: Results of a Multicenter Trial Comparing Heparin and A New Fibrinolytic Agent

The Divisions of Nuclear Medicine of Centre Jean Perrin, Clermont-Ferrand, of the University Hospital of Besançon, and of the University Hospital of Grenoble, France

Correspondence: For reprints contact: J.C. Maublant, MD, Nuclear Medicine, Centre Jean Perrin, 63011 Clermont-Ferrand, France.

ABSTRACT

In a multicenter randomized double-blind trial comparing heparin and a new fibrinolytic agent, anisoylated plasminogen streptokinase activator complex (APSAC), 231 patients presenting with a < 5 hr acute myocardial infarction underwent a contrast angiography (CA) before the end of the first week of admission, and radionuclide cardiac blood-pool imaging and a ²⁰¹Tl single photon emission computed tomography (SPECT) study before the end of the third week. Left ventricular ejection fraction (LVEF) and a wall motion score (WM) were calculated from CA. LVEF was also obtained from cardiac blood-pool imaging, and defect size (DS) from ²⁰¹Tl SPECT. Results demonstrated that all parameters were significantly improved in patients treated with APSAC versus heparin (contrast LVEF 53 ± 13 vs. 47 ± 14 p < 0.01, WM 9.8 ± 6.5 vs. 13.3 ± 7.9 p < 0.001, radionuclide LVEF 43 ± 12 vs. 40 ± 13 p < 0.05, DS 14 ± 12 vs. 18 ± 14 p < 0.05). When the patients were divided according to infarct site and infarct-related coronary artery patency, it was demonstrated with all four parameters that the beneficial effect of APSAC can be largely explained by the lower incidence of vessel obstruction in this group (37% vs. 77% in the heparin group, p < 0.001). It is concluded that (a) when compared with heparin and in the conditions of the trial, APSAC significantly improves the cardiac function and decreases the DS and (b) DS measured by ²⁰¹Tl SPECT is as valuable a quantitative parameter of therapeutic evaluation as are LVEF and WM.

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				J. Kellett and J. Clarke Comparison of "Accelerated" Tissue Plasminogen Activator with Streptokinase for Treatment of Suspected Myocardial Infarction Med Decis Making, October 1, 1995; 15(4): 297 - 310. [Abstract] [PDF]