Estimation of myocardial infarct size by electrocardiographic and radionuclide techniques

The Western Washington Intravenous Streptokinase in Acute Myocardial Infarction Trial was a randomized, experimental, multicenter clinical study comparing intravenous streptokinase therapy to conventional therapy of acute myocardial infarction. Myocardial infarct size was estimated by spatial vectorcardiography in 93 patients in the treatment group and 80 patients in the control group eight weeks post MI. The estimated infarct size for the treated group was smaller: 16 +/- 10% MI vs. 20 +/- 9% MI for the control group, P = 0.01. Four independent techniques to estimate infarct size were prospectively compared within the same day: Cowan's spatial VCG; the Selvestor/Wagner QRS score; 99m technetium synchronized ejection fractions and 201-Thallium Tomography. There was strong correlation between the two ECG techniques (r = 0.88) and between the two radionuclide techniques (r = 0.77). Statistically significant correlations (P = 0.0001) were described, respectively, among the four techniques, but the correlations were not clinically strong between electrocardiographic and radionuclide techniques: IAD vs. EF, r = -0.41; IAD vs. 201-Tl, r = 0.50; QRS Score vs. EF, r = -0.49; QRS Score vs. 201-Tl, r = 0.58.