LIMITED USEFULNESS OF EXERCISE TESTING AND THALLIUM SCINTIGRAPHY IN EVALUATION OF AMBULATORY PATIENTS SEVERAL MONTHS AFTER RECOVERY FROM ANACUTE CORONARY EVENT - IMPLICATIONS FOR MANAGEMENT OF STABLE CORONARYHEART-DISEASE
Rj. Krone et al., LIMITED USEFULNESS OF EXERCISE TESTING AND THALLIUM SCINTIGRAPHY IN EVALUATION OF AMBULATORY PATIENTS SEVERAL MONTHS AFTER RECOVERY FROM ANACUTE CORONARY EVENT - IMPLICATIONS FOR MANAGEMENT OF STABLE CORONARYHEART-DISEASE, Journal of the American College of Cardiology, 24(5), 1994, pp. 1274-1281
Objectives. This study evaluated the value of noninvasive test- ing to
predict cardiac events in patients with stable coronary disease after
hospital admission (and risk stratification) for an acute coronary ev
ent. Background. Exercise testing with thallium perfusion imaging iden
tifies patients with obstructive coronary artery disease and has been
used to stratify patients after myocardial infarction. Its usefulness
for predicting cardiac events in patients with stable coronary disease
after recovery from an acute coronary event was explored. Methods. Ni
ne hundred thirty-six patients were enrolled 1 to 6 months after hospi
tal admission for a coronary event. Patients underwent exercise treadm
ill testing with planar thallium-201 scintigraphy and were followed up
for an average of 23 months (range 6 to 43). End points were 1) unsta
ble angina requiring hospital admission, nonfatal myocardial infarctio
n or cardiac death; 2) nonfatal infarction or cardiac death; or 3) car
diac death alone. Results. Twelve patients died of cardiac causes (1.2
%); 32 had a nonfatal myocardial infarction (3.4%); and 79 patients (8
.4%) devel- oped unstable angina in the first year. Exercise testing i
mproved proportional hazards models constructed from clinical variable
s for all three end points (p < 0.05). The perfusion scan further impr
oved models for the end points (nonfatal infarction or cardiac death a
nd cardiac death alone, p < 0.05). However, the exercise test with or
without thallium added little to the overall prediction of primary eve
nts (area under the receiver operating curve increased from 0.649 to 0
.663), and only 2% to 13% of patients with abnormal results either had
a nonfatal infarction or died. Conclusions. Thallium-201 scintigraphy
and exercise testing variables identify patients at risk for subseque
nt cardiac events. However, the poor predictive performance of these t
ests in this group of patients with stable coronary disease severely l
imits their usefulness. These results suggest a limited role for exerc
ise and thallium testing in predicting cardiac events in patients with
known coronary disease.