Bayesian analysis of stress thallium scintigraphy for the detection of multivessel coronary disease

This study was performed in 224 men to determine the respectivecontribution of history and thallium-201 stress myocardial scintigraphicimaging in the non-invasive prediction of the severity of coronarydisease. Myocardial scintigraphic imaging had the better diagnostic accuracy(80%) for the detection of multivessel disease but the resultsemphasize the importance of the history in predicting the extentof coronary artery disease. In patients with myocardial infarction, the diagnostic accuracyof the history (80%) was similar to the diagnostic accuracyof myocardial scintigraphic imaging (79%), in the subgroup ofpatients with residual angina pectoris after infarction, theaccuracy of the history was even greater (87%) than that ofmyocardial scintigraphic imaging (78%). Thus, after myocardialinfarction, scintigraphy was useful only in the small subgroupof patients without residual angina pectoris when it had a diagnosticaccuracy of 79%, slightly but insignificantly superior to thatof the history (62%). In patients without previous myocardialinfarction, but with typical angina, myocardial scintigraphywas clearly superior to the simple history (diagnostic accuracyof 78% versus 53%; P < 0.001). In patients without myocardialinfarction and with atypical angina the prevalence of multivesseldisease was low (17%) and the diagnostic accuracy of history(83%) was barely different from the diagnostic accuracy of myocardialscintigraphic imaging (90%). Thus, when the likelihood of multivesseldisease is very high (angina pectoris post myocardial infarction),or very low (atypical angina), the contribution of exercisetesting is very limited. Important additional information isprovided by maximal exercise testing and myocardial scintigraphicimaging only in the groups with an intermediate prevalence ofmultivessel disease, namely in the asymptomatic patients aftermyocardial infarction and in the patients with typical anginabut no previous myocardial infarction.