ADENOSINE TL-201 TOMOGRAPHY IN EVALUATION OF GRAFT PATENCY LATE AFTERCORONARY-ARTERY BYPASS GRAFT-SURGERY

Objectives. We sought to ascertain the utility of adenosine thallium-2 01 tomography for assessing graft stenoses late after coronary artery bypass graft surgery. Background. Although pharmacologic perfusion ima ging has been increasingly used in the assessment of patients with cor onary artery disease, the value of this stress modality for detecting coronary artery bypass graft stenosis late after surgery is unknown. M ethods. We studied 109 patients who underwent both adenosine thallium 201 tomography and coronary angiography at 6.7 +/- 4.8 (mean +/- SD) y ears after coronary artery bypass graft surgery. Adenosine thallium-20 1 tomography was assessed quantitatively by computer-generated polar m aps of the myocardial thallium-201 activity. Results. On coronary angi ography, significant graft stenoses were present in 68 patients, 65 of whom had a corresponding perfusion defect as shown by thallium-201 to mography (sensitivity 96%). Significant stenoses were present in 107 ( 37.8%) of 283 grafts. The overall specificity by quantitative tomograp hy was 61%. Seventy percent of the apparently false positive perfusion defects could be explained on the basis of unbypassed native disease or by the presence of fixed defects in patients with previous myocardi al infarction. Conclusions. Thus, results of adenosine thallium-201 to mography are nearly always abnormal in patients with late coronary gra ft stenosis. Most of the false positive defects appear to be due to ei ther unbypassed native disease or a previous myocardial infarction. (C ) 1997 by the American College of Cardiology.