PROGNOSTIC IMPLICATIONS OF NORMAL EXERCISE TOMOGRAPHIC THALLIUM IMAGES IN PATIENTS WITH ANGIOGRAPHIC EVIDENCE OF SIGNIFICANT CORONARY-ARTERY DISEASE

This study examines the prognostic implications of normal exercise tom ographic thallium images in medically treated patients with angiograph ic evidence of coronary artery disease (CAD). There were 97 patients a ged 60 +/- 10 years; 52 had 1-, 30 had 2-, and 15 had 3-vessel CAD (gr eater than or equal to 50% diameter stenosis). The exercise test was s ubmaximal in 51 patients (53%); ST-segment depression during exercise occurred in 20 patients (21%), and angina during exercise occurred in 23 patients (24%). Most patients (71%) were receiving antianginal ther apy. During a mean follow-up of 32 months, only 3 patients had cardiac events: 2 died of cardiac causes and 1 had nonfatal myocardial infarc tion (event rate 1.1%/year). None of those 3 patients had positive ST response during exercise. Thus, medically treated patients with CAD (i ncluding those with multivessel CAD) have a benign prognosis in the pr esence of nor mal exercise thallium images. These results have importa nt implications in patient management and cost of health delivery.