Noninvasive evaluation of total occlusion of infarct-related coronary artery after a first myocardial infarction.

Abstract

Previous studies have demonstrated that the long-term prognosis after acute myocardial infarction in patients whose infarct-related artery remains occluded is worse than that in those with anterograde flow. To determine how to identify patients with occluded infarct-related arteries noninvasively, 143 consecutive patients after a first myocardial infarction underwent exercise testing and dipyridamole thallium scintigraphy. The incidence of total occlusion was higher in inferior/posterior infarction than in anterior infarction (29/53 vs 28/90; p = 0.005). In patients with inferior/posterior infarction, discriminant analysis revealed a sensitivity of 79%, a specificity of 88% and an accuracy of 83% (p = 0.0005) in identifying those with an occluded infarct-related artery. In patients with anterior infarction, the analysis showed a sensitivity of 68%, a specificity of 85% and an accuracy of 79% (p < 0.0001) in identifying those with an occluded artery. These results indicate that noninvasive study may be useful in the evaluation of total occlusion of the infarct-related coronary artery.