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CLINICAL STUDIES

Effects of medical therapy on outcome assessment using exercise thallium-201 single photon emission computed tomography imaging

Evidence of a protective effect of beta-blocking antianginal medications

Pierre Y. Marie, MD^*, Nicolas Danchin, MD, Fabrice Branly, MD^*, Michaël Angioï, MD, Alain Grentzinger, MD, Jean M. Virion, MSc, Benoit Brouant, MD, Pierre Olivier, MD^*, Gilles Karcher, MD^*, Yves Juillière, MD, Faïez Zannad, MD and Alain Bertrand, MD^*

^* Department of Nuclear Medicine, UPRES EA 2403, CHU Nancy, France
Department of Cardiology, UPRES EA 2403, CHU Nancy, France
Department of Medicine Computer Science, Epidemiology and Statistics, UPRES EA 2403, CHU Nancy, France

Manuscript received November 21, 1997; revised manuscript received February 16, 1999, accepted March 19, 1999.

Reprint requests and correspondence: Pr. Pierre-Yves Marie, Service de Médecine Nucléaire, CHU Nancy-Brabois, 54511 Vandoeuvre Cedex, France
py.marie{at}CHU-nancy.fr

OBJECTIVES

The purpose of this study was to determine whether antianginal medications modify the prognostic significance of exercise single photon emission computed tomography (SPECT) ischemia.

BACKGROUND

Antianginal medications (especially beta-adrenergic blocking agents) limit exercise SPECT ischemia, but it is not known whether such medications also modify the prognostic effect of exercise SPECT ischemia.

METHODS

We included 352 patients with coronary heart disease, who had exercise Tl-201 SPECT and coronary angiography, and who were initially treated medically. Survival Cox models were applied in patients for whom classes of antianginal medications taken at exercise SPECT were the same as those prescribed for follow-up (GI; n = 136), and in patients for whom new classes of antianginal medications, including beta-blockers (GII; n = 79) or not including beta-blockers (GIII; n = 113), were added for follow-up.

RESULTS

During a mean 5.3 ± 1.6 years of follow-up, 45 patients had cardiac death or myocardial infarction. Variables reflecting necrosis (irreversible defect extent, left ventricular ejection fraction) and those from coronary angiography provided equivalent prognostic information in the three groups. In contrast, the SPECT variable reflecting ischemia (reversible defect extent), which provided comparable prognostic information in GI (p = 0.005) and GIII (p = 0.004), lost its prognostic significance (p = 0.54) in GII, and was associated with a lower relative risk in GII than in GI or GIII (both p < 0.05).

CONCLUSIONS

In patients with coronary heart disease, the introduction of antianginal medications, when including beta-blockers, appears to have a favorable effect on the deleterious prognostic effect of exercise ischemia.

Abbreviations and Acronyms   CHD = coronary heart disease   CI = confidence interval   LAD = left anterior descending coronary artery   RR = relative risk   SPECT = single photon emission computed tomography

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