Prognostic value of thallium-201 myocardial perfusion imaging in patients with unstable angina who respond to medical treatment

Department of Medicine, University of Vermont College of Medicine, Burlington.

Although the prognostic value of thallium-201 imaging is well established, its ability to risk stratify patients who present with unstable angina is unclear. Fifty-two consecutive patients admitted with unstable angina who responded to medical treatment and underwent stress thallium-201 imaging within 1 week of discharge were studied. Patients were followed up for 39 +/- 11 months. Cardiac events included cardiac death (n = 3), nonfatal myocardial infarction (n = 4) and admission for unstable angina or revascularization (n = 17). The ability of thallium-201 data (redistribution, fixed defects, normal) to predict cardiac events was compared with clinical data (age, gender, prior myocardial infarction, anginal syndrome, rest and stress electrocardiogram) and cardiac catheterization data using logistic regression. Thallium-201 redistribution was the only significant predictor of cardiac death or nonfatal myocardial infarction (p less than 0.05). The number of myocardial segments with thallium-201 redistribution (p less than 0.0005) and a history of prior myocardial infarction (p less than 0.05) were the only significant predictors of all cardiac events. Cardiac death or nonfatal myocardial infarction occurred more frequently in patients with thallium-201 redistribution (6 [26%] of 23) than in those without redistribution (1 [3%] of 29, p less than 0.05). Similarly, total cardiac events developed more frequently in patients with thallium-201 redistribution (p less than 0.001). Stress thallium-201 imaging has important prognostic value in patients admitted with unstable angina who respond to medical therapy and can identify subgroups at high versus low risk for future cardiac events.

This article has been cited by other articles:

				Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology Eur. Heart J., July 1, 2007; 28(13): 1598 - 1660. [Full Text] [PDF]

				A. Elhendy, A. F.L. Schinkel, R. T. van Domburg, J. J. Bax, R. Valkema, A. Huurman, H. H. Feringa, and D. Poldermans Risk Stratification of Patients with Angina Pectoris by Stress 99mTc-Tetrofosmin Myocardial Perfusion Imaging J. Nucl. Med., December 1, 2005; 46(12): 2003 - 2008. [Abstract] [Full Text] [PDF]

				R. Moreno, A. Villate, J. Zamorano, C. Almeria, J.-A. Perez-Gonzalez, J.-L. Rodrigo, L. P. de Isla, L. Mataix, and C. Macaya Identifying patients without favourable long-term outcome among those with medically stabilized unstable angina and a negative dipyridamole stress echocardiogram Eur J Echocardiogr, June 1, 2004; 5(3): 205 - 211. [Abstract] [Full Text] [PDF]

				U. N. Khot, G. Jia, D. J. Moliterno, A. M. Lincoff, M. B. Khot, R. A. Harrington, and E. J. Topol Prognostic Importance of Physical Examination for Heart Failure in Non-ST-Elevation Acute Coronary Syndromes: The Enduring Value of Killip Classification JAMA, October 22, 2003; 290(16): 2174 - 2181. [Abstract] [Full Text] [PDF]

				Committee Members, F. J. Klocke, M. G. Baird, B. H. Lorell, T. M. Bateman, J. V. Messer, D. S. Berman, P. T. O'Gara, B. A. Carabello, R. O. Russell Jr, et al. ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging) J. Am. Coll. Cardiol., October 1, 2003; 42(7): 1318 - 1333. [Full Text] [PDF]

				F. J. Klocke, M. G. Baird, B. H. Lorell, T. M. Bateman, J. V. Messer, D. S. Berman, P. T. O'Gara, B. A. Carabello, R. O. Russell Jr, M. D. Cerqueira, et al. ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging) Circulation, September 16, 2003; 108(11): 1404 - 1418. [Full Text] [PDF]

				M. E. Bertrand, M. L. Simoons, K. A.A. Fox, L. C. Wallentin, C. W. Hamm, E. McFadden, P. J. De Feyter, G. Specchia, and W. Ruzyllo Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation Eur. Heart J., December 1, 2002; 23(23): 1809 - 1840. [Full Text] [PDF]

				R. Florenciano-Sanchez, J. A. Castillo-Moreno, E. Molina-Laborda, M. Jimenez-Pascual, P. Garcia-Urruticoechea, S. Egea-Beneyto, J. G. Sanchez-Villanueva, and J. Ortega-Bernal The exercise test that indicates a low risk of events: Differences in prognostic significance between patients with chronic stable angina and patients with unstable angina J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1974 - 1979. [Abstract] [Full Text] [PDF]

				M.E Bertrand, M.L Simoons, K.A.A Fox, L.C Wallentin, C.W Hamm, E McFadden, P.J de Feyter, G Specchia, and W Ruzyllo Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology: Recommendations of the Task Force of the European Society of Cardiology Eur. Heart J., September 1, 2000; 21(17): 1406 - 1432. [PDF]

				L.A. Pierard Evaluating risk in unstable angina: role of pharmacological stress echocardiography Eur. Heart J., July 1, 2000; 21(13): 1041 - 1043. [PDF]

				M Sitges, C Pare, M Azqueta, X Bosch, M VelamazaN, J Magrina, and G Sanz Feasibility and prognostic value of dobutamine-atropine stress echocardiography early in unstable angina Eur. Heart J., July 1, 2000; 21(13): 1063 - 1071. [Abstract] [PDF]

				B. P. Mandalapu, M. Amato, and H. G. Stratmann Technetium Tc 99m Sestamibi Myocardial Perfusion Imaging: Current Role for Evaluation of Prognosis Chest, June 1, 1999; 115(6): 1684 - 1694. [Abstract] [Full Text] [PDF]