A Comprehensive Strategy of Risk Stratification for Patients with Acute Myocardial Infarction Using Tc-99m Sestamibi

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The field of nuclear cardiology has produced several new perfusion tracers within the last several years, and several more seem to be on the way. The major promise of these new radiopharmaceuticals is the delivery of superior perfusion images compared with those supplied by thallium-201. which has been the standard isotope over the last 20 years for myocardial perfusion. The imaging characteristics are enhanced by the incorporation of technetium-99m (Tc-99m) as the radioactive element because of its higher photon energy and shorter half-life as compared with thallium- 201.

The prototype of these new agents is Tc-99m sestamibi, which has been approved by the Foot) and Drug Administration for general use.

This review will discuss how this agent has changed the approach and management of patients with acute myocardial infarction. The ability to quantify jeopardized myocardium, subsequent infarct size, and myocardial salvage will be examined, as well as more refined methods in predicting the short-term outcome in such patients. The use of perfusion imaging as a triage strategy for patients with chest pain syndromes will also be discussed. Finally, a comprehensive management scheme will be presented to risk stratify patients treated with reperfusion therapy for acute myocardial infarction.

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