PROGNOSTIC VALUE OF ADENOSINE SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHIC THALLIUM IMAGING IN MEDICALLY TREATED PATIENTS WITH ANGIOGRAPHIC EVIDENCE OF CORONARY-ARTERY DISEASE

Background. This study examined the prognostic value of adenosine sing le-photon emission computed tomographic thallium imaging in medically treated patients with angiographic evidence of coronary artery disease (CAD). Methods and Results. Patients who underwent coronary revascula rization within 3 months of this study were excluded. There were 177 p atients aged 64 +/- 11 years; 74 had one-vessel, 57 had two-vessel, an d 46 had three-vessel CAD (greater than or equal to 50% diameter steno sis). During a mean follow-up of 22 +/- 13 months, there were 14 event s (cardiac death or nonfatal myocardial infarction). Cox survival anal ysis with important clinical, catheterization, and scintigraphic varia bles identified the size of perfusion abnormality as the strongest pre dictor of events (chi(2) = 9). Life-table analysis showed that patient s with perfusion defects of 15% or greater of the myocardium had a wor se prognosis than had patients with no or smaller defects (Mantel-Cox statistic = 13; p < 0.001). Conclusions. Thus adenosine single-photo e mission computed tomographic thallium imaging provides important progn ostic data in medically treated patients with CAD. The extent of thall ium abnormality is the most important predictor of events.