Identification of high-risk patients with left main and three-vessel coronary artery disease by adenosine-single photon emission computed tomographic thallium imaging

Academic Article

Abstract

  • The purpose of this study was to examine the ability of SPECT imaging with thallium-201 during adenosine-induced coronary hyperemia to detect highrisk patients with left main or three-vessel CAD. There were 339 patients: 102 with either left main or three-vessel CAD (group 1) and 237 with no CAD, one-, or two-vessel disease (group 2). By means of univariate analysis, several variables were found to differ between groups 1 and 2: Q wave myocardial infarction (35% vs 25%, p < 0.05), ST segment depression (35% vs 19%, p < 0.001), age (67 ± 9 vs 62 ± 10 years, p < 0.001), resting systolic blood pressure (142 ± 22 vs 135 ± 20 mm Hg, p < 0.01), abnormal thallium images (95% vs 74%, p < 0.0001), multivessel thallium abnormality (76% vs 39%, p < 0.0001), extent of thallium abnormality (24 ± 11% vs 19 ± 13%, p < 0.0001), and increased lung thallium uptake (39% vs 15%, p < 0.01). According to stepwise discriminant analysis, only three variables were predictors of high risk: multivessel thallium abnormality (x2 = 27), increased lung thallium uptake (x2 = 10), and ST depression (x2 = 5). On the basis of these variables, patients were divided into three groups with different prevalence rates for left main and three-vessel CAD: 63% in 68 patients, 30% in 137 patients, and 13% in 137 patients. Thus adenosine-thallium imaging permits stratification of patients into different risk groups; 20% of patients have a high, 40% an intermediate, and 40% a low prevalence of left main or three-vessel CAD. © 1993.
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    Author List

  • Iskandrian AS; Heo J; Lemlek J; Ogilby JD; Untereker WJ; Iskandrian B; Cave V
  • Start Page

  • 1130
  • End Page

  • 1135
  • Volume

  • 125
  • Issue

  • 4