Key result
A secondary 99mTc-MIBI scan at 3 months revealed myocardial viability in 10% (3 of 30) of STEMI patients with initially nonviable myocardium, with no significant relationship to Rentrop class.
Why the study?
Collateral vessels may help damaged tissue regain function, suggesting that a secondary myocardial perfusion scintigraphy could reassess viability in late-presenting STEMI patients whose initial scan showed nonviable myocardium.
Does a secondary delayed 99mTc-MIBI nuclear scan at 3 months detect myocardial viability in STEMI patients with delayed referral and initial nonviable myocardium?
Cohort (n=30)
No
Does a secondary delayed 99mTc-MIBI nuclear scan at 3 months detect myocardial viability in STEMI patients with delayed referral and initial nonviable myocardium?
A small proportion of STEMI patients with initially nonviable myocardium may demonstrate viability on a delayed secondary scan at 3 months, suggesting a potential role for reassessment before definitively withholding revascularization.
Answers are grounded in this paper and cite their sources.
Collateral flow may aid recovery in nonviable post-STEMI myocardium; leaves open whether to revise viability-based revascularization decisions.
OBJECTIVE: In the management of ST-segment elevation myocardial infarction (STEMI), if the treatment has not been initiated within the first 24 h and the patient no longer exhibits any symptoms, the decision to begin revascularization therapy is based on myocardial viability. If the tissue is nonviable, current guidelines advise against further revascularization therapy; however, collateral vessels represent an alternative source of blood supply and may help the damaged tissue to resume function; though at first, this tissue may not be considered viable. Thus, in patients whose first myocardial perfusion scintigraphy (MPS) revealed nonviable myocardium, a secondary MPS to assess viability may be beneficial and alter the course of treatment strategies. METHODS: This prospective cohort study was conducted on 30 STEMI patients referred to Mazandaran Heart Center. If no myocardial viability was found using 99mTc-MIBI MPS, the patient was referred for a secondary MPS after 3 months. RESULTS: In total, out of 30 patients, 3 became viable. There was no significant relationship between the viability of different Rentrop classes. Comparison of viability between patients with different numbers of occluded vessels showed no significant relationship. Three patients (17%) among 17 patients with Rentrop class nonzero became viable in the second MPS. Also, among four patients (13.3%) with Rentrop class three, one patient (25%) became viable and among seven patients (23.3%) with Rentrop class one, two patients (28.6%) became viable. CONCLUSION: Considering the results of this study, although nonsignificant, this subject requires further investigation to reach a definite conclusion.
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Farsavian et al. (2023) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=30). Secondary 99mTc-MIBI myocardial perfusion scintigraphy was evaluated on Myocardial viability on secondary MPS. A secondary 99mTc-MIBI scan at 3 months revealed myocardial viability in 10% (3 of 30) of STEMI patients with initially nonviable myocardium, with no significant relationship to Rentrop class.
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