| Objective To compare the efficacy of primary angioplasty and selective angioplasty in patients with acute myocardial infarction (AMI), and evaluate the myocardial viability and cardiac function in patients with coronary heart disease after PCI therapy using 99Tcm-MIBI/18F-FDG gated myocardial tomography with dual isotope simultaneous acquisition(DISA). Methods A total of 63 patients with coronary heart disease underwent PCI therapy, including primary PCI group(21 patients,MIl group) and selective PCI group(20 patients,MI2 group) after AMI and unstable angina pectorisis group(22 patients,UA group), 17 cases as control group(C group) diagnosed as normal coronary artery by CAG .During hospitalization myocardial viability and cardiac function were assessed using DISA and UCG in a week after PCI or CAGTo compare LVEF, LVEDV, LVESV and WMSI. 3-6 months later after PCI MI1 group and MI2 group were evaluated again using UCG and 99Tcm-MIBI gated SPECT. Results The sensitivity and specificity of DISA were 90. 5% and 82.4%.In the cases with LAD as IRA or culprit vessel,the sensitivity was 88.5%.In those with LCX or RCA as IRA or culprit vessel,the sensitivity was 65.2% or 85.7%.The sensitivity of DISA to detect single-vessel,two-vessel and multi-vessel stenosis were 80% (20/25), 86.4% (19/22) > 87.5 % ( 14/16 ) . The percentages myocardial segments of hypoperfusion and improved FDG uptake in primary PCI group were 21.7%(41/189) and 70.7%(29/41),while in selective PCI group were 34.3%(62/180) and 43.5%(27/62).In UA group the percentages were 21.2%(42/198) and 83%(35/42).There was significant difference between Mil group and MI2 group (P<0. 05) ,but no difference between Mil group and UA group.There was significant difference between Mil and MI2 in LVEF (56.1+10.7% vs 50.8±9.0%,P<0.05). There was no difference between Mil and MI2inEDV (75.6±19.5ml vs 84.1±22.7ml,P>0.05) ,ESV (48.4±10.3ml vs 53.9±12.4ml, P>0. 05 ) and WMS (2.1+2.5 vs 2.6±1.2, P>0.05 ) .Compared with UA group,EDV,ESV of ^11 an(j mj2 group were more larger(P<0.05).There was no difference in WMS between UA group and MI1,MI2 group.Difference was found in EDV,ESV,WMS between C group and MI1,MI2 group(P<0.05).There existed no difference in EDV,ESV between UA group and C group,while WMS of UA group was different from that of C group(P<0.05). Conclusions 1 The study shows that primary PCI is more effetive than selective PCI in retrieving viable myocardium and protecting cardiac function after AMI.2 There exists inviable myocardium in patients with UA.It is very important to perform revascularization therapy to UA patients in order to improve prognosis and left ventricular function.3 The sensitivity and specificity of DISA were 90. 5% and 82.4 % .In the cases with LAD or RCA as IRA or culprit vessel,the sensitivity was higher than that with LCX as IRA or culprit vessel.The sensitivity of DISA increased as the number of vessel with stenosis increased.4 DISA and 99Tcm-MIBI gated SPECT is useful in evaluate the myocardial perfusion,myocardial viability and cardiac function.But in patients accompanied with diabetes mellitus, it is... |
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