A comparative study of primary coronary stenting and intravenous thrombolysis for acute myocardial infarction using 99mTc-MIBI SPECT imaging

The therapeutic effectiveness of primary coronary stenting was evaluated and compared with that of intravenous thrombolysis for acute myocardial infarction (AMI) using 99mTc-MIBI myocardial SPECT imaging. 42 patients with AMI were undergone primary coronary stenting (stenting group, 23 patients) or intravenous thrombolysis therapy (thrombolysis group, 19 patients). 99mTc-MIBI myocardium SPECT imaging was performed before and 1 week after stenting or thrombolysis therapy. The left ventricular myocardium of each patient was divided into 20 segments. The semiquantitative score of myocardial 99mTc-MIBI uptake was expressed with a five-point scoring system: 0 = normal; 1 = equivocal; 2 = mild defect; 3 = severe defect; 4 =absence of activity. The scores of scanning before stenting or intravenous thrombolysis was SBS. The scores of scanning after stenting or intravenous thrombolysis was SAS. Deducting SAS from SBS was SDS. A comparison was made between the stenting group and thrombolysis group: SBS was 41.3 +- 9.8 and 39.4 +- 7.9 (t = 1.2, p < 0.05); SAS was 17.8 +- 6.4 and 27.3 +- 6.7 (t=5.8, p < 0.01); SDS was 24.5 +- 4.2 and 12.2 +- 2.3 (t = 7.3, p < 0.01). In the 193 defect segments before stenting, 106 segments (54.9%) restored to normal after stenting. In the 149 defect segments before intravenous thrombolysis, 61 segments (40.9%) restored to normal after thrombolysis therapy. Comparing between stenting group and thrombolysis group in the improved rate of myocardial perfusion defect scores there was a significant difference (p < 0.01). 99mTc-MIBI myocardial SPECT imaging has been proved to be an objective parameter for evaluating the therapeutic effectiveness of the stenting and the intravenous thrombolysis in the treatment of AMI. The results indicated that primary coronary stenting seems to be more effective than intravenous thrombolysis