Yaser, Siti Nooraein
(2019)
Baseline Technetium-99m Tetrofosmin Myocardial Perfusion Study In Predicting The Management Outcome Of Patients With Newly Diagnosed Myocardial Infarction.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background: Thrombolytic therapy is one of the treatment modality in ST elevation
myocardial infarction (STEMI) although percutaneous coronary intervention (PCI) is an
established gold standard treatment. Myocardial Perfusion Study (MPS) is one of the
diagnostic modalities that can be used for risk stratification post STEMI. The purpose
of this research is to study the role of MPS in predicting the management outcome in
newly diagnosed STEMI patients.
Methods: Post STEMI with thrombolytic treatment referred for MPS were included in
this study. MPS findings including semi quantitative analysis of severity of ischaemia,
automated summed difference score (SDS), left ventricular ejection fraction (LVEF),
end diastolic volume (EDV) and end systolic volume (ESV) were obtained. Follow up
was done 12 months after baseline MPS. Primary outcome on types of management
with secondary outcome were studied in relation to MPS findings.
Results: Seven patients had encountered cardiac hard events 12 months after the
baseline MPS. All were male with mean age of 54.3 years old. Analysis of MPS
findings and primary outcome found that moderate to severe ischemia, SDS of 5 - 6
(OR = 49.875; 95% CI 11.30 – 220.16), SDS of ≥7 (OR = 39.35; 95% CI 10.51 –
147.35), and LVEF ≥35% had significant unadjusted increased chance for
revascularisation. Moderate to severe ischemia (OR = 285.8; 95% CI 28.15 - 2902.08)
and LVEF ≥ 35%(OR = 54.04; 95% CI 6.10 – 478.56) had significant increased chance
for revascularisation when adjusted to other confounding factors in multivariate
analysis. Meanwhile LVEF of 23.7% with range 17-29% (OR = 0.593; 95% CI 0.39 –
0.9), EDV of 172.6 ml with range 155-197 mls (OR = 1.13; 95% CI 1.05 – 1.21), and
ESV of 130.9 ml with range 110-141 mls (OR = 1.16; 95% CI 1.03 –1.31) had
significant unadjusted increased chance of cardiac hard events.
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