Circulation, Vol 77, 745-758, Copyright © 1988 by American Heart Association
S Kaul, DR Lilly, JA Gascho, DD Watson, RS Gibson, CA Oliner, JM Ryan and GA Beller
The goal of this study was to determine the prognostic utility of the
exercise thallium-201 stress test in ambulatory patients with chest pain
who were also referred for cardiac catheterization. Accordingly, 4 to 8
year (mean +/- 1SD, 4.6 +/- 2.6 years) follow-up data were obtained for all
but one of 383 patients who underwent both exercise thallium-201 stress
testing and cardiac catheterization from 1978 to 1981. Eighty-three
patients had a revascularization procedure performed within 3 months of
testing and were excluded from analysis. Of the remaining 299 patients, 210
had no events and 89 had events (41 deaths, nine nonfatal myocardial
infarctions, and 39 revascularization procedures greater than or equal to 3
months after testing). When all clinical, exercise, thallium-201, and
catheterization variables were analyzed by Cox regression analysis, the
number of diseased vessels (when defined as greater than or equal to 50%
luminal diameter narrowing) was the single most important predictor of
future cardiac events (chi 2 = 38.1) followed by the number of segments
demonstrating redistribution on delayed thallium-201 images (chi 2 = 16.3),
except in the case of nonfatal myocardial infarction, for which
redistribution was the most important predictor of future events. When
coronary artery disease was defined as 70% or greater luminal diameter
narrowing, the number of diseased vessels significantly (p less than .01)
lost its power to predict events (chi 2 = 14.5). Other variables found to
independently predict future events included change in heart rate from rest
to exercise (chi 2 = 13.0), ST segment depression on exercise (chi 2 =
13.0), occurrence of ventricular arrhythmias on exercise (chi 2 = 5.9), and
beta-blocker therapy (chi 2 = 4.3). The exclusion of myocardial
revascularization procedures as an event did not change the results
significantly. Although the number of diseased vessels was the single most
important determinant of future events, the exercise thallium-201 stress
test when considered as a whole (which included the number of segments
demonstrating redistribution on delayed thallium-201 images, change in
heart rate from rest to exercise, ST segment depression on the
electrocardiogram, and ventricular premature beats on exercise) was equally
powerful (chi 2 = 41.6). Combination of both catheterization and exercise
thallium-201 data was superior to either alone (chi 2 = 57.5) for
determining future events. Exercise stress test alone (without thallium-201
data) was inferior to the exercise thallium-201 stress test or cardiac
catheterization for predicting future events (chi 2 = 30.6).(ABSTRACT
TRUNCATED AT 400 WORDS)
ARTICLES
Prognostic utility of the exercise thallium-201 test in ambulatory patients with chest pain: comparison with cardiac catheterization
Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville 22908.
This article has been cited by other articles:
 |
|
 |
|
  R. Hachamovitch, S. W. Hayes, J. D. Friedman, I. Cohen, and D. S. Berman Stress myocardial perfusion single-photon emission computed tomography is clinically effective and cost effective in risk stratification of patients with a high likelihood of coronary artery disease (CAD) but no known CAD J. Am. Coll. Cardiol., January 21, 2004; 43(2): 200 - 208. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. G. Hundley, T. M. Morgan, C. M. Neagle, C. A. Hamilton, P. Rerkpattanapipat, and K. M. Link Magnetic Resonance Imaging Determination of Cardiac Prognosis Circulation, October 29, 2002; 106(18): 2328 - 2333. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. V. Williams, S. D. Fihn, and R. J. Gibbons Guidelines for the Management of Patients with Chronic Stable Angina: Diagnosis and Risk Stratification Ann Intern Med, October 2, 2001; 135(7): 530 - 547. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K.C. Allman and L.E.J. Thomson Prognostic value of myocardial perfusion imaging in patients with known or suspected coronary artery disease Eur. Heart J. Suppl., September 1, 2001; 3(suppl_F): F5 - F7. [Abstract] [PDF]
|
|
|
|
|
|
L. A. Diaz, R. C. Brunken, E. H. Blackstone, C. E. Snader, and M. S. Lauer Independent contribution of myocardial perfusion defects to exercise capacity and heart rate recovery for prediction of all-cause mortality in patients with known or suspected coronary heart disease J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1558 - 1564. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons, K. Chatterjee, J. Daley, J. S. Douglas, S. D. Fihn, J. M. Gardin, M. A. Grunwald, D. Levy, B. W. Lytle, R. A. O'Rourke, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina) J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2092 - 2197. [Full Text] [PDF]
|
|
|
|
 |
|
 G. C. Kloehn and R. A. O'Rourke Perioperative Risk Stratification in Patients Undergoing Noncardiac Surgery: Kloehn, GC and O'Rourke, RA Perioperative Risk Stratification in Patients Undergoing Noncardiac Surgery J Intensive Care Med 1999,14 95-108 J Intensive Care Med, March 1, 1999; 14(2): 95 - 108. [Abstract] [PDF]
|
|
|
|
|
|
R. Hachamovitch, D. S. Berman, H. Kiat, I. Cohen, J. A. Cabico, J. Friedman, and G. A. Diamond Exercise Myocardial Perfusion SPECT in Patients Without Known Coronary Artery Disease : Incremental Prognostic Value and Use in Risk Stratification Circulation, March 1, 1996; 93(5): 905 - 914. [Abstract] [Full Text]
|
|
|
|
|
|
G. F. Fletcher, G. Balady, V. F. Froelicher, L. H. Hartley, W. L. Haskell, and M. L. Pollock Exercise Standards : A Statement for Healthcare Professionals From the American Heart Association Circulation, January 15, 1995; 91(2): 580 - 615. [Full Text]
|
|
|
|
 |
|
 G. A. M. Pop, P. J. Koudstaal, H. J. Meeder, A. Algra, J. C. van Latum, J. van Gijn, and Dutch TIA Trial Study Group Predictive Value of Clinical History and Electrocardiogram in Patients With Transient Ischemic Attack or Minor Ischemic Stroke for Subsequent Cardiac and Cerebral Ischemic Events Arch Neurol, April 1, 1994; 51(4): 333 - 341. [Abstract] [PDF]
|
|
|
|
 |
|
 J. A. Leppo, A. Iskandrian, K. A. Brown, and M. S. Verani Noninvasive Testing for Silent Myocardial Ischemia in Stable Coronary Patients JAMA, October 20, 1993; 270(15): 1809 - 1809. [Abstract] [PDF]
|
|
|
|
|
|
A. J. Moss, R. E. Goldstein, W. J. Hall, J. T. Bigger Jr, J. L. Fleiss, H. Greenberg, M. Bodenheimer, R. J. Krone, F. I. Marcus, F. J. Th. Wackers, et al. Detection and Significance of Myocardial Ischemia in Stable Patients After Recovery From an Acute Coronary Event JAMA, May 12, 1993; 269(18): 2379 - 2385. [Abstract] [PDF]
|
|
|
|
|
|
M. M. Bodenheimer Risk Stratification in Coronary Disease: A Contrary Viewpoint Ann Intern Med, June 1, 1992; 116(11): 927 - 936. [Abstract] [PDF]
|
|
|
|
|
|
T. S. Kotler and G. A. Diamond Exercise Thallium-201 Scintigraphy in the Diagnosis and Prognosis of Coronary Artery Disease Ann Intern Med, November 1, 1990; 113(9): 684 - 702. [Abstract] [PDF]
|
|