Journal of Nuclear Cardiology

, Volume 25, Issue 2, pp 572–580 | Cite as

Assessment of the area at risk after acute myocardial infarction using 123I-MIBG SPECT: Comparison with the angiographic APPROACH-score

  • Fabien Vauchot
  • Fayçal Ben Bouallègue
  • Christophe Hedon
  • Christophe Piot
  • François Roubille
  • Denis Mariano-Goulart
Original Article



Assessment of the area at risk (AAR) associated with an acute myocardial infarction is crucial for evaluating prevention and revascularization strategies. The aim of this study was to evaluate whether 123I-metaiodobenzylguanidine (123I-MIBG) single-photon emission computed tomography (SPECT) provides a more widely available assessment of anatomical AAR than the established anatomical angiographic methods.


Seventy patients with ST-segment elevation acute myocardial infarction (STEMI) underwent coronary angiography with percutaneous coronary intervention and subsequent 123I-MIBG myocardial scintigraphy with left myocardial relative radiotracer uptake evaluation 12 ± 10 days after STEMI. Patients were divided into two groups depending on whether the culprit artery was occluded (50 patients) or sub-occluded (20 patients). Two scores were calculated as a percentage of the left ventricular myocardium surface, the first using a standard 17-segment summed rest score derived from the relative quantitative evaluation of 123I-MIBG myocardial uptake (MAR) and the second using the modified APPROACH-score (ApAR).


For the patients with occluded artery, this study showed a high correlation between MAR and the angiographic score (Pearson r = .762 and P < .0001). For the patients with sub-occluded artery, for which the ApAR is not reliable, this study showed no correlation between MAR and the angiographic score (Pearson r = .18 and P = 0.45).


123I-MIBG myocardial scintigraphy provides ARR assessment similar to that of ApAR in patients with a single occluded coronary artery. However, MAR differs from ApAR when angiographic scores are known to be inaccurate (sub-occluded culprit artery) or impossible to use. Further studies are needed to evaluate the potential clinical interest of 123I-MIBG SPECT as an alternative for area at risk assessment after STEMI even when the culprit artery is sub-occluded or when the angiographic scores cannot be used.


Myocardial infarction area at risk 123I-MIBG SPECT coronary angiography 



Area at risk


Modified APPROACH-score evaluation of the area at risk


123I-MIBG evaluation of the area at risk


Left ventricle


Percutaneous coronary intervention


ST-segment elevation acute myocardial infarction




Single-photon emission computed tomography




Mean segmental activity


Magnetic resonance imaging



There is no conflict of interest to declare.

Supplementary material

12350_2016_644_MOESM1_ESM.pptx (316 kb)
Supplementary material 1 (PPTX 316 kb)


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Copyright information

© American Society of Nuclear Cardiology 2016

Authors and Affiliations

  • Fabien Vauchot
    • 1
  • Fayçal Ben Bouallègue
    • 1
  • Christophe Hedon
    • 2
  • Christophe Piot
    • 3
    • 5
  • François Roubille
    • 2
    • 4
  • Denis Mariano-Goulart
    • 1
    • 4
  1. 1.Department of Nuclear MedicineMontpellier University HospitalMontpellier Cedex 5France
  2. 2.Department of CardiologyMontpellier University HospitalMontpellier Cedex 5France
  3. 3.Department of CardiologyClinique du MillénaireMontpellier Cedex 2France
  4. 4.PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214Montpellier Cedex 5France
  5. 5.IGF - UMR5203 - U1191 – UMMontpellierFrance

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