| Prediction of death and myocardial infarction by screening with exercise-thallium testing after coronary-artery-bypass grafting. | |
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MedLine Citation:
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PMID: 9500316 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The role of myocardial-perfusion imaging in calculating risk in symptom-free patients who have had coronary-artery-bypass grafting (CABG) is unclear. Practice guidelines have argued against routine screening of these patients. We sought to find out the independent and incremental prognostic value of exercise thallium-201 single-photon-emission computed tomography (SPECT) for prediction of death and non-fatal myocardial infarction (MI) in these patients. METHODS: Analyses were based on 873 symptom-free patients undergoing symptom-limited exercise thallium-201 SPECT between September, 1990, and December, 1993. All had undergone CABG and none had recurrent angina or other major intercurrent coronary events. Exercise and thallium-perfusion variables were analysed to determine their prognostic importance during 3 years of follow-up. FINDINGS: Myocardial-perfusion defects were noted in 508 (58%) patients. There were 57 deaths and 72 patients had major events (death or non-fatal MI). Patients with thallium-perfusion defects were more likely to die (9% vs 3%, p=0.0004) or suffer a major event (11% vs 4%, p=0.0002). Reversible defects were also predictive of death (12% vs 5%, p=0.002) and major events (13% vs 7%, p=0.004). The exercise variable with the strongest predictive power was an impaired (< or = 6 METs [measure of oxygen consumption equal to 3.5 mL/kg/min]) exercise capacity; poor exercise capacity was predictive of death (18% vs 4%, p<0.0001) and death or non-fatal MI (19% vs 5%, p<.00001). After adjusting for baseline clinical variables, surgical variables, time elapsed since CABG, and standard cardiovascular risk factors, thallium-perfusion defects remained predictive of death (adjusted relative risk 2.78, 95% CI 1.44-5.39) and major events (2.63, 1.49-4.66). Similarly, impaired exercise remained strongly predictive of death (4.16, 2.38-7.29) and major events (3.61, 2.22-5.87) after adjusting for confounders. INTERPRETATION: In this group of patients who were symptom-free after CABG, thallium-perfusion defects and impaired exercise capacity were strong and independent predictors of subsequent death or non-fatal MI. Recommendations against routine screening exercise myocardial-perfusion studies in this setting should be reconsidered. |
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Authors:
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M S Lauer; B Lytle; F Pashkow; C E Snader; T H Marwick |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Lancet Volume: 351 ISSN: 0140-6736 ISO Abbreviation: Lancet Publication Date: 1998 Feb |
Date Detail:
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Created Date: 1998-03-17 Completed Date: 1998-03-17 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 2985213R Medline TA: Lancet Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 615-22 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, George M and Linda H Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Ohio 44195, USA. lauerm@cesmtp.ccf.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Coronary Artery Bypass* Exercise Test / economics, methods* Female Health Care Costs Heart / radionuclide imaging* Humans Male Middle Aged Mortality* Myocardial Infarction / mortality, radionuclide imaging* Postoperative Complications / radionuclide imaging* Prognosis Risk Factors Statistics as Topic Thallium Radioisotopes / diagnostic use* Time Factors Tomography, Emission-Computed, Single-Photon* |
| Chemical | |
Reg. No./Substance:
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0/Thallium Radioisotopes |
| Comments/Corrections | |
Comment In:
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Lancet. 1998 May 23;351(9115):1586; author reply 1586-7
[PMID:
10326568
]
Lancet. 1998 May 23;351(9115):1585; author reply 1586-7 [PMID: 10326567 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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