The late prognostic value of acute scintigraphic measurement of myocardial infarction size.

Infarct, perfusion and blood pool scintigraphy were performed in 62 patients during hospitalization for acute myocardial infarction. The largest measured infarct or perfusion image defect and left ventricular ejection fraction were related to the late prognosis determined a mean of 16 months after the event. Breakpoint values for all scintigraphic variables could separate those who were asymptomatic on follow-up from those who died. The best indicators for selection of survivors and nonsurvivors were a scintigraphic infarct size greater than or equal to 25 cm2 and a perfusion abnormality greater than or equal to 35% of the projected left ventricular area. Among patients with perfusion abnormalities above this limit, 61% died; 93% of those with small perfusion abnormalities survived. Scintigraphic measurements of relative myocardial perfusion and function best separated patients asymptomatic on follow-up from those who developed heart failure and also best identified those with an unfavorable evolution, who developed heart failure or died. Early scintigraphic parameters appeared more accurate than other clinical laboratory indicators for determining late prognosis and could be important in planning treatment after acute infarction.