PROGNOSTIC-SIGNIFICANCE FROM 10-YEAR FOLLOW-UP OF A QUALITATIVELY NORMAL PLANAR EXERCISE THALLIUM TEST IN SUSPECTED CORONARY-ARTERY DISEASE

A normal exercise thallium-201 scintigram has been shown to confer an excellent prognosis over a 1- to 4-year follow-up period. However, pro gression of coronary disease could result in cardiovascular mortality with increasing time. Therefore, the vital status of 309 patients with normal stress thallium myocardial imaging was determined after an ave rage of 10.3 years. Deaths were classified as cardiac or noncardiac. S tatistical analysis was performed using Kaplan-Meier survival curves. Standardized mortality ratios were calculated and compared with those of an age- and sex-matched general population. Follow-up was complete in 288 patients (93%). Of 18 deaths, only 3 were cardiac; the remainin g 15 were mainly secondary to cancer. Thus, cardiac mortality was 1% a nd total mortality 6.3% at 10 years. In addition, both all-cause and c ardiac mortality rates were significantly less than would be expected in an age- and sex-adjusted segment of the general population. Thus, n ormal exercise thallium scintigraphy retains its high negative predict ive value of death less-than-or-equal-to 10 years after initial testin g. This supports the use of stress thallium imaging to predict which p atients with suspected coronary artery disease are at low ridk for car diac death and thus do no need invasive testing.