Role of exercise thallium-201 myocardial perfusion scintigraphy in predicting prognosis in suspected coronary artery disease |
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| Authors: | J H Koss S M Kobren A M Grunwald M M Bodenheimer |
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| Affiliation: | 1. Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;2. Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;3. Yale School of Medicine, New Haven, Connecticut;1. Division of Pulmonary/Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States;2. Division of Pulmonary/Critical Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States;3. Department of Medicine, Massachusetts General Hospital, Boston, MA, United States;4. Division of Healthcare Policy, Harvard Medical School, Boston, MA, United States;5. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States;6. Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark;2. Oregon Health and Science University, Knight Cardiovascular Institute, Portland, Oregon;3. Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland;4. Boston Scientific, St. Paul, Minnesota;5. The Valley Hospital, Ridgewood, New Jersey;2. Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands;1. Kafkas University Medical Faculty, Department of Cardiology, Kars, Turkey;2. Kars Harakani State Hospital, Department of Cardiology, Kars, Turkey;3. Health Science University, Sultan Abdulhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey;4. Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Department of Cardiology, Ankara, Turkey;5. Ataturk University Medical Faculty, Department of Cardiology, Erzurum, Turkey |
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| Abstract: | While exercise thallium imaging has improved sensitivity and specificity for detection of coronary artery disease (CAD), its predictive value for morbid cardiac events is unclear. Of 532 consecutive patients who underwent exercise thallium imaging, follow-up was complete in 515 (97%) after an average of 36 months (range 31 to 48). Two hundred six patients had an abnormal exercise thallium response and 309 had a normal response. Twenty morbid cardiac events occurred (13 deaths and 7 acute myocardial infarctions [AMI]). Of the 13 patients who died, 12 had abnormal thallium results. Overall, 5.8% of the patients with abnormal thallium results died, in contrast to 0.3% of patients with normal results. Of the 7 patients who had a nonfatal AMI, 3 had abnormal exercise thallium results. Moreover, similar proportions of patients (1.4% and 1.3%) with normal and abnormal exercise thallium results had nonfatal AMI. Presence or absence of pathologic Q waves and inclusion of exercise electrocardiographic results did not significantly alter the results. Thus, although a normal exercise thallium response significantly reduces the likelihood of cardiovascular death, its predictive value for nonfatal AMI is limited. Moreover, the relatively low event rate for patients with a positive exercise thallium response further limits its prognostic value. |
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