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Prognostic Implications

Abdulmassih S. Iskandrian, MD; Abdul-Hamid Hakki, MD; Sally Kane-Marsch, RN

Arch Intern Med. 1986;146(11):2189-2193.

Abstract
• We studied the prognostic value of exercise thallium-201 imaging in 196 men with suspected or known coronary artery disease who had nondiagnostic exercise electrocardiograms. The perfusion images in each of three projections were divided into three segments; each segment was assessed for perfusion defects (fixed or reversible). There were 12 cardiac events at a mean follow-up of 15 months (range, one to 66 months). Of those, five patients died of cardiac causes and seven had nonfatal acute myocardial infarctions (MIs). Only the number of perfusion defects significantly predicted cardiac events; clinical presentation, history of MI, presence of Q-wave MI, exercise duration, and exercise heart rate and double product did not predict cardiac events or add to information provided by the number of defects. Furthermore, actuarial life-table analysis showed that patients with three or more perfusion defects had significantly worse prognoses than patients with fewer than three defects. Exercise thallium-201 imaging helps in risk stratification of men with nondiagnostic exercise electrocardiograms.

(Arch Intern Med 1986;146:2189-2193)

Author Affiliations
From the Likoff Cardiovascular Institute, Hahnemann University Hospital, Philadelphia.

Footnotes
Accepted for publication Feb 10, 1986.

Read in part at the 57th Annual Scientific Sessions of the American Heart Association, Miami, Nov 15, 1984, and at the 32nd annual meeting of the Society of Nuclear Medicine, Houston, June 3,1985.

Reprint requests to Nuclear Cardiology Laboratory, Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA 19102 (Dr Iskandrian).

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