Document Detail

Prediction of death and myocardial infarction by screening with exercise-thallium testing after coronary-artery-bypass grafting.
MedLine Citation:
PMID:  9500316     Owner:  NLM     Status:  MEDLINE    
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.
M S Lauer; B Lytle; F Pashkow; C E Snader; T H Marwick
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Lancet     Volume:  351     ISSN:  0140-6736     ISO Abbreviation:  Lancet     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-03-17     Completed Date:  1998-03-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  615-22     Citation Subset:  AIM; IM    
Department of Cardiology, George M and Linda H Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Ohio 44195, USA.
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MeSH Terms
Coronary Artery Bypass*
Exercise Test / economics,  methods*
Health Care Costs
Heart / radionuclide imaging*
Middle Aged
Myocardial Infarction / mortality,  radionuclide imaging*
Postoperative Complications / radionuclide imaging*
Risk Factors
Statistics as Topic
Thallium Radioisotopes / diagnostic use*
Time Factors
Tomography, Emission-Computed, Single-Photon*
Reg. No./Substance:
0/Thallium Radioisotopes
Comment In:
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 ]

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