Prognostic value of thallium-201 single-photon emission computed tomography for patients with multivessel coronary artery disease after revascularization (the emory angioplasty versus surgery trial [EAST])

The aim of this study was to investigate the relation between reversible th allium single-photon emission computed tomegraphy (SPECT) myocardial perfus ion defects at 1-year after revascularization and quantitative indexes in E mery Angioplasty versus Surgery Trial (EAST) and outcomes 3 years after rev ascularization in 336 patients. EAST was a randomized controlled trial asse ssing cardiac outcomes for angioplasty versus bypass surgery for patients w ith multivessel coronary artery disease. During this prospective trial, a s ubstudy included the evaluation of the prognostic value of reversible defec ts on quantitative thallium SPECT. At 1-year after revascularization, 336 p atients underwent SPECT thallium-201 stress myocardial perfusion and 3-hour delayed imaging. Subsequent events, percutaneous transluminal coronary ang ioplasty, coronary artery bypass graft surgery, myocardial infarction, and death, were recorded at 3 years. A stress-induced reversible thallium-201 d efect was defined using a quantitative index of a reversibility score >30% and severity score >500. Reversible defects were observed more frequently i n the percutaneous transluminal coronary angioplasty than in the coronary a rtery bypass graft surgery treatment groups (46% vs 27%, p <0.001). A fetal of 123 patients had stress-induced, reversible thallium defects and more e vents than patients with other perfusion results (freedem from ail events w as 81.3% vs 94% [p <0.001], and freedom from myocardial infarction and deat h 88.3% vs 95.5% [p = 0.031]). Quantitative thallium SPECT at 1 year after revascularization risk stratifies patients as to their likelihood of major cardiac outcomes. (C) 1999 by Excerpta Medico, Inc.