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Gated SPECT Evaluation of the Relationship Between Admission Troponin I, Myocardial Salvage, and Functional Recovery in Acute Myocardial Infarction Treated by Abciximab and Early Primary Angioplasty

¹ Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy
² Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
³ Nuclear Medicine Unit, Misericordia e Dolce Hospital, Prato, Italy

Using gated SPECT, we evaluated the relationship between admission troponin I, risk area, and myocardial salvage in patients with a first myocardial infarction treated with abciximab and primary percutaneous coronary intervention within 6 h. Methods: In 43 patients, ^99mTc-sestamibi was injected before primary percutaneous coronary intervention. Gated SPECT was acquired immediately thereafter and was repeated 7 and 30 d later. The initial risk area and subsequent infarct size were expressed as a percentage of the left ventricle; salvage index was the ratio between salvaged myocardium and initial risk area; left ventricular ejection fraction was calculated using the quantitative gated SPECT software. Results: On admission, 20 patients showed elevated troponin I and had a larger risk area (P < 0.03) than did the group with normal troponin I. Infarct size at 30 d (15% ± 12% vs. 13% ± 13%) and salvage index (0.63 ± 0.27 vs. 0.60 ± 0.28) were not significantly different between the 2 groups. Ejection fraction was lower in the group with high troponin I on admission (36% ± 10% vs. 41% ± 11%, P < 0.05) and at 7 d (41% ± 11% vs. 48 ± 10, P < 0.03). At 30 d, improvement was greater in the group with high troponin I, and ejection fraction became comparable. Conclusion: Patients with high troponin I on admission have a larger initial risk area, but if they undergo primary percutaneous coronary intervention within 6 h and are treated with abciximab, myocardial salvage and functional recovery are similar to those observed in patients with normal troponin I, and no unfavorable relationship between high troponin I values on admission and myocardial salvage is registered.

Key Words: abciximab • gated SPECT • myocardial infarction • percutaneous coronary intervention • troponin

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