Prognostic value of thallium-201 single-photon emission computed tomography for patients with multivessel coronary artery disease after revascularization (the Emory Angioplasty versus Surgery Trial [EAST]).
The aim of this study was to investigate the relation between reversible thallium single-photon emission computed tomography (SPECT) myocardial perfusion defects at 1-year after revascularization and quantitative indexes in Emory Angioplasty versus Surgery Trial (EAST) and outcomes 3 years after revascularization in 336 patients. EAST was a randomized controlled trial assessing cardiac outcomes for angioplasty versus bypass surgery for patients with multivessel coronary artery disease. During this prospective trial, a substudy included the evaluation of the prognostic value of reversible defects on quantitative thallium SPECT. At 1-year after revascularization, 336 patients underwent SPECT thallium-201 stress myocardial perfusion and 3-hour delayed imaging. Subsequent events, percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, myocardial infarction, and death, were recorded at 3 years. A stress-induced reversible thallium-201 defect was defined using a quantitative index of a reversibility score >30% and severity score >500. Reversible defects were observed more frequently in the percutaneous transluminal coronary angioplasty than in the coronary artery bypass graft surgery treatment groups (46% vs 27%, p <0.001). A total of 123 patients had stress-induced, reversible thallium defects and more events than patients with other perfusion results (freedom from all events was 81.3% vs 94% [p <0.001], and freedom from myocardial infarction and death 88.3% vs 95.5% [p = 0.031]). Quantitative thallium SPECT at 1 year after revascularization risk stratifies patients as to their likelihood of major cardiac outcomes.
Alazraki
N P
NP
Department of Radiology, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia, USA. nalazra@emory.edu
Krawczynska
E G
EG
Kosinski
A S
AS
DePuey
E G
EG
Ziffer
J A
JA
Taylor
A T
AT
Pettigrew
R I
RI
Vansant
J P
JP
Shaw
L J
LJ
Weintraub
W S
WS
King
S B
SB
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002423:Cause of Death; D001026:Coronary Artery Bypass; D003326:Coronary Circulation / Q000502:physiology; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005080:Exercise Test; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
D013794:Thallium Radioisotopes