Identification of high-risk patients with left main and three-vessel coronary artery disease by adenosine-single photon emission computed tomographic thallium imaging.
The purpose of this study was to examine the ability of SPECT imaging with thallium-201 during adenosine-induced coronary hyperemia to detect high-risk patients with left main or three-vessel CAD. There were 339 patients: 102 with either left main or three-vessel CAD (group 1) and 237 with no CAD, one-, or two-vessel disease (group 2). By means of univariate analysis, several variables were found to differ between groups 1 and 2: Q wave myocardial infarction (35% vs 25%, p < 0.05), ST segment depression (35% vs 19%, p < 0.001), age (67 +/- 9 vs 62 +/- 10 years, p < 0.001), resting systolic blood pressure (142 +/- 22 vs 135 +/- 20 mm Hg, p < 0.01), abnormal thallium images (95% vs 74%, p < 0.0001), multivessel thallium abnormality (76% vs 39%, p < 0.0001), extent of thallium abnormality (24 +/- 11% vs 19 +/- 13%, p < 0.0001), and increased lung thallium uptake (39% vs 15%, p < 0.01). According to stepwise discriminant analysis, only three variables were predictors of high risk: multivessel thallium abnormality (chi 2 = 27), increased lung thallium uptake (chi 2 = 10), and ST depression (chi 2 = 5). On the basis of these variables, patients were divided into three groups with different prevalence rates for left main and three-vessel CAD: 63% in 68 patients, 30% in 137 patients, and 13% in 137 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Iskandrian
A S
AS
Philadelphia Heart Institute, Presbyterian Medical Center, PA 19104.
Heo
J
J
Lemlek
J
J
Ogilby
J D
JD
Untereker
W J
WJ
Iskandrian
B
B
Cave
V
V
D000241:Adenosine / Q000009:adverse effects; D000368:Aged; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013793:Thallium; D015899:Tomography, Emission-Computed, Single-Photon
D013793:Thallium; D000241:Adenosine