Failure of gated single photon emission computer tomography scan to detect imminent acute plaque rupture causing acute ST-elevation myocardial infarction: Case report

The negative predictive value of a gated single photon emission computer tomography (SPECT) scan is very high, with an event rate of < 1% in the first year. However, the presence of nonobstructive coronary artery plaque should yield normal SPECT scan findings. On the other hand, most plaque ruptures, which are a major cause of acute myocardial infarction, occur in nonobstructive coronary artery plaque. Therefore, the findings of a gated SPECT scan should be normal if a ruptured plaque has not created significant obstruction despite the imminent threat of coronary artery occlusion. We present the first case report of a documented gated SPECT scan in a patient who had experienced an acute anterior Q-wave myocardial infarction showing no significant ischemia in the anterior wall in the last minute of data acquisition.