Noninvasive prediction of multivessel disease after myocardial infarction.

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Abstract
In 65 patients with a previous transmural myocardial infarction (anterior in 33, inferior in 32), exercise Tl scanning was compared with 12-lead exercise ECG to detect multivessel disease. At coronary arteriography 40 patients had multivessel disease (.gtoreq. 70% diameter stenosis in 2 or 3 vessels) and 25 patients had 1 vessel disease. On the exercise scan Tl defects corresponding to the ECG infarction site were present in all patients. Patients with 1 vessel and multivessel disease were separated by exercise-induced angina, perfusion defects on the exercise Tl scan in more than 1 specific vascular area and a positive exercise ECG associated with angina; but not by a positive exercise ECG alone. Of the 40 patients with multivessel disease, 85% had defects in more than 1 vascular area on the Tl scan and 70% had a positive exercise ECG (P = NS [not significant]. Of the 37 patients with Tl defects in more than 1 specific vascular area, 92% had multivessel disease, compared with 72% of the 39 patients who had a positive exercise ECG (P < 0.05). Periinfarctional ischemia was present in 38 of the 65 patients (58%) (14 of 25 with 1 vessel disease and 24 of 40 with multivessel disease), and did not correlated with the severity of the corresponding coronary artery disease. Tl defects that resolved in a 2nd vascular area were associated with the resolving rather than a constant defect in the vascular area where the infaction had occurred (P < 0.005). After a transmural myocardial infarction, multivessel disease can be better differentiated from 1 vessel disease by Tl scanning.