Detection of Residual Infarct-related Coronary Artery Stenosis and Multivessel Disease After Thrombolysis: Comparison Between Myocardial Contrast Echocardiography and Single Photon Emission Computed Tomography

Abstract

Detection of residual infarct-related artery (IRA) stenosis and multivessel disease (MVD) after thrombolysis has important therapeutic and prognostic implications. Technetium 99m sestamibi single photon emission computed tomography (SPECT) is used for detection of flow-limiting coronary artery disease (CAD). Myocardial contrast echocardiography (MCE) is a new technique developed to assess CAD. We aimed to compare the relative accuracy of vasodilator stress MCE and SPECT for detection of IRA stenosis and MVD after acute myocardial infarction. Accordingly, 72 patients underwent simultaneous MCE and SPECT 7 +/- 2 days after thromobolysis. Coronary angiography was performed in all patients. Of the 72 patients, 60 demonstrated significant myocardial viability of which 55 (92%) showed significant IRA stenosis (> 50%). MVD was present in 30 (42%) of the 72 patients. MCE was more accurate than SPECT for detection of both IRA stenosis (85% vs 62%, P = .02) and MVD (85% and 64%, P = .004). MCE was comparable to SPECT for the detection of IRA stenosis and MVD after thrombolysis.