This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kwok, J. M. F. Articles by Gibbons, R. J. Search for Related Content PubMed PubMed Citation Articles by Kwok, J. M. F. Articles by Gibbons, R. J.

CLINICAL STUDIES

Identification of severe coronary artery disease in patients with a single abnormal coronary territory on exercise thallium-201 imaging

The importance of clinical and exercise variables

^a Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
^b Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Manuscript received September 22, 1998; revised manuscript received September 3, 1999, accepted October 19, 1999.

Reprint requests and correspondence: Dr. Timothy F. Christian, Mayo Clinic E-16B, 200 First Street SW, Rochester, Minnesota 55902

OBJECTIVES

The aim of this study was to determine which clinical, exercise and thallium variables can aid in the identification of three-vessel or left main coronary artery disease (3VLMD) in patients with one abnormal coronary territory (either a reversible or fixed defect) on exercise thallium testing and to test the prognostic value of these variables.

BACKGROUND

Although the sensitivity of detection of coronary artery disease by thallium-201 imaging is high, the actual detection of 3VLMD by thallium tomographic images alone is not optimal.

METHODS

A multivariate model for prediction of 3VLMD was developed from several clinical, exercise and thallium-201 variables in a training population of 264 patients who had one abnormal coronary artery territory on exercise thallium testing and had undergone coronary angiography. Using this model, patients were stratified into risk groups for prediction of 3VLMD. A separate validation cohort of 474 consecutive patients who were treated initially with medical therapy and who had one abnormal coronary territory were divided into identical risk groupings by the variables derived from the training population, and they were followed for a median of 7.0 years to evaluate the prognostic value of this model.

RESULTS

The prevalence of 3VLMD was 26% in the training population despite one abnormal thallium coronary territory. Four clinical and exercise variables—diabetes, hypertension, magnitude of ST segment depression, and exercise rate-pressure product—were found to be independent predictors of 3VLMD. In the training population, the prevalence of 3VLMD in low-, intermediate- and high-risk groups was 15%, 22% and 51%, respectively. When the multivariate model was applied to the validation population, the eight-year overall survival rates in the low-, intermediate- and high-risk groups were 89%, 73% and 75%, respectively (p < 0.001).

CONCLUSIONS

A substantial proportion of patients with one abnormal thallium coronary territory have 3VLMD with subsequent divergent outcomes based upon risk stratification by clinical and exercise variables. Consequently, the finding of only a single abnormal coronary territory by thallium-201 perfusion imaging does not necessarily confer a benign prognosis in the absence of consideration of nonimaging variables.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   CAD = coronary artery disease   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   SPECT = single-photon emission computed tomography   3VLMD = three-vessel or left main disease

This article has been cited by other articles:

				L. D. Metz, M. Beattie, R. Hom, R. F. Redberg, D. Grady, and K. E. Fleischmann The Prognostic Value of Normal Exercise Myocardial Perfusion Imaging and Exercise Echocardiography: A Meta-Analysis J. Am. Coll. Cardiol., January 16, 2007; 49(2): 227 - 237. [Abstract] [Full Text] [PDF]

				E. R. Hayek, H. A. White, and R. W. Kamienski Identification of Severe Left Main Trunk Coronary Stenosis on MDCT Coronary Angiography Am. J. Roentgenol., January 1, 2007; 188(1): W93 - W93. [Full Text] [PDF]

				O. Pereztol-Valdes, J. Candell-Riera, C. Santana-Boado, J. Angel, S. Aguade-Bruix, J. Castell-Conesa, E. V. Garcia, and J. Soler-Soler Correspondence between left ventricular 17 myocardial segments and coronary arteries Eur. Heart J., December 2, 2005; 26(24): 2637 - 2643. [Abstract] [Full Text] [PDF]

				C Y Loong and C Anagnostopoulos Diagnosis of coronary artery disease by radionuclide myocardial perfusion imaging Heart, August 1, 2004; 90(suppl_5): v2 - v9. [Full Text] [PDF]

				S. A. J. Chamuleau, R. A. Tio, C. C. de Cock, E. D. de Muinck, N. H. J. Pijls, B. L. F. van Eck-Smit, K. T. Koch, M. Meuwissen, M. G. W. Dijkgraaf, A. de Jong, et al. Prognostic value of coronary blood flow velocity and myocardial perfusion in intermediate coronary narrowings and multivessel disease J. Am. Coll. Cardiol., March 6, 2002; 39(5): 852 - 858. [Abstract] [Full Text] [PDF]

				J. Auer, R. Berent, B. Eber, R. A. O'Rourke, T. Chaudhuri, L. Shaw, and D. S. Berman Anti-Ischemic Therapy and Myocardial Ischemia Shown by Single Photon Emission Computed Tomography Imaging Circulation, December 11, 2001; 104 (24): e151 - e152. [Full Text] [PDF]

				W. Keeble, W. Martin, and I. Hutton Reduced global myocardial thallium uptake--an important marker of severe coronary artery disease J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2352 - 2352. [Full Text] [PDF]

				T. F. Christian Reduced global myocardial thallium uptake--an important marker of severe coronary artery disease: Reply J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2352 - 2353. [Full Text] [PDF]