Persistence of an Abnormal Pattern on 99mTc Pyrophosphate Myocardial Scintigraphy Following Acute Myocardial Infarction

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Abstract
Seventy patients, 69 males and one female, were studied by 99mTc pyrophosphate myocardial scintig-raphy more than six weeks after a documented myocardial infarction. History, physical examination, ECG, and serum enzyme measurements were obtained at the time of scintigraphy. All 70 patients were outpatients with no evidence of recurrent infarction since their myocardial infarction. Sixty-four of the 70 patients had angina pectoris or congestive heart failure. The scintigrams were interpreted by two observers. Images were scored on a scale of 1 + to 3 + for intensity of myocardial activity and were either diffuse or regional in distribution. Activity of 2 + or greater was considered positive. Of the 70 patients, 36 (51%) had myocardial scintigrams which were interpreted as positive for acute myocardial infarction and 34 (49%) as negative for acute myocardial infarction. Correlation of the clinical status with the scintigram revealed the following: all six asymptomatic patients had negative scintigrams; of the 32 patients with Class II angina, 15 were positive and 17 were negative; 10 of 14 patients with Class III angina were positive; 8 of 11 with angina and congestive heart failure (CHF) were positive; and 3 of 7 with CHF alone had positive scintigrams. In 54 of the patients who had previous scintigraphy at the time of acute infarction, the followup scintigram showed definite improvement in 48 patients and was the same or worse in 6 patients. Of these 6 patients, 2 showed scintigraphic evidence of reinfarction with a focal abnormality involving a different wall than on the original study. Furthermore, these were the only 2 among the 70 patients where the myocardial activity was graded at 3 +. Therefore, patients who have had previous myocardial infarctions with no clinical evidence of recurrent infarction may have persistent abnormalities on repeat myocardial scintigraphy. Meaningful interpretation is possible, however, by correlation with the clinical status and comparison with previous scintigraphy.

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