Document Detail


Incremental prognostic value of exercise thallium-201 myocardial single-photon emission computed tomography late after coronary artery bypass surgery.
MedLine Citation:
PMID:  7829794     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study assessed the incremental prognostic value of exercise thallium-201 myocardial perfusion single-photon emission computed tomography (SPECT) performed > or = 5 years after coronary artery bypass surgery. BACKGROUND: Thallium-201 scintigraphy has shown significant prognostic value in a variety of populations with suspected and known coronary artery disease. However, its value in patients with previous bypass surgery remains unknown. METHODS: We studied 294 patients who were prospectively followed up. Cox proportional hazards models for prediction of "hard" events (cardiac death and nonfatal infarctions) were constructed, with variables considered for inclusion in hierarchic order: clinical and exercise data first, followed by scintigraphic information. RESULTS: Mean (+/- SD) follow-up duration after scintigraphy was 31 +/- 11 months. There were 20 cardiac deaths and 21 nonfatal acute myocardial infarctions. Twenty-nine patients had late (> 60 days after thallium-201 SPECT) revascularization procedures or underwent repeat bypass surgery or percutaneous transluminal angioplasty. Shortness of breath and peak exercise heart rate were the most important clinical predictors of hard events. Two scintigraphic variables added significant prognostic information to the clinical model: the thallium-201 summed reversibility score (summation of segmental differences between stress and redistribution scores) and the presence of increased lung uptake of the radiotracer. The global chi-square statistic for this model was twice as high as that for the clinical/exercise model alone (49.7 vs. 24.2). When a second multivariate Cox model was built adding "soft" events (i.e., late revascularization procedures) as outcomes of interest, the summed reversibility score was selected as an independent scintigraphic predictor of events. The global chi-square statistic for this model was 50.7, three times as high as that for the clinical/exercise model alone. CONCLUSIONS: After evaluation of treadmill and exercise data, thallium-201 myocardial perfusion SPECT provided incremental prognostic information in patients late after bypass.
Authors:
W Palmas; S Bingham; G A Diamond; T A Denton; H Kiat; J D Friedman; D Scarlata; J Maddahi; I Cohen; D S Berman
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  25     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1995 Feb 
Date Detail:
Created Date:  1995-02-22     Completed Date:  1995-02-22     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  403-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California 90048.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Artery Bypass*
Coronary Disease / epidemiology,  radionuclide imaging*,  surgery
Disease-Free Survival
Exercise Test
Female
Follow-Up Studies
Heart / radionuclide imaging*
Humans
Male
Prognosis
Proportional Hazards Models
Reoperation
Thallium Radioisotopes / diagnostic use*
Time Factors
Tomography, Emission-Computed, Single-Photon*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Thallium Radioisotopes
Comments/Corrections
Comment In:
J Am Coll Cardiol. 1995 Nov 15;26(6):1560-2   [PMID:  7594085 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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