Independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in coronary artery disease.
OBJECTIVE
The objective of this study was to examine the independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in patients with angiographically defined coronary artery disease.


BACKGROUND
Previous studies showed the importance of exercise thallium-201 in risk stratification. However, most of these studies used planar imaging techniques.


METHODS
Follow-up data were obtained in 316 medically treated patients with coronary artery disease. Cox proportional hazards regression models were used to examine the independent and incremental prognostic values of clinical, exercise, thallium and cardiac catheterization data.


RESULTS
There were 35 events (cardiac death or nonfatal myocardial infarction) at a mean follow-up time of 28 months. Univariate analysis showed that gender (chi-square = 5.1), exercise work load (chi-square = 3.1), extent of coronary artery disease and left ventricular ejection fraction (chi-square = 14.8) and thallium variables (chi-square = 22.7) were prognostically important. The thallium data provided incremental prognostic value to catheterization data (chi-square = 33.7, p < 0.01). The extent of the perfusion abnormality was the single best predictor of prognosis (chi-square = 14). Patients with a large perfusion abnormality had a worse prognosis than that of patients with a mild or no abnormality (Mantel-Cox statistics = 10.6, p < 0.001).


CONCLUSIONS
In medically treated patients with coronary artery disease, exercise SPECT thallium imaging provides independent and incremental prognostic information even when catheterization data are available. The extent of the perfusion abnormality is the single most important prognostic predictor.
Iskandrian
A S
AS
Philadelphia Heart Institute, Presbyterian Medical Center, Pennsylvania 19104.
Chae
S C
SC
Heo
J
J
Stanberry
C D
CD
Wasserleben
V
V
Cave
V
V
D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods / Q000706:statistics & numerical data
D013794:Thallium Radioisotopes