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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

View larger version (23K): [in a new window]   Figure 1 Main prognostic indicators: comparisons of the relative risks (±95% confidence interval) provided by the Cox analyses performed in the three groups: GI (solid circles), GII (open circles) and GIII (striped circles). * p < 0.05. LAD = left anterior descending coronary artery; LV = left ventricle.

View larger version (14K): [in a new window]   Figure 2 Comparison, inside each of the three groups, of the Kaplan-Meier major-event–free survival curves, between patients who had (solid squares) and those who did not have (open circles) significant exercise ischemia at baseline (reversible defect >5% of left ventricle). Number below the abscissa = number of event-free patients at each 20-month follow-up interval.

View larger version (23K): [in a new window]   Figure 3 Incremental prognostic value of extent of reversible Tl-201 single photon emission computed tomography (SPECT) defects, relative to those provided by the combination of clinical, exercise testing and catheterization data. Analysis was performed in the three groups (GI, GII and GIII). The initial models included: left ventricular ejection fraction, number of 70% diseased vessels, proximal left anterior descending artery stenosis and age. In each group, total chi-square values are shown for the initial models (hatched bars) and for the final models obtained after the addition of extent of reversible Tl-201 SPECT defects (solid bars).