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Use of exercise thallium-201 imaging for risk stratification of elderly patients with coronary artery disease
A S Iskandrian1, J Heo, D Decoskey
1Philadelphia Heart Institute, Presbyterian-University of Pennsylvania Medical Center 19104.
Insights
Exercise thallium-201 imaging effectively predicts cardiac events in elderly patients with coronary artery disease (CAD). Abnormal imaging results, particularly multi-vessel abnormalities and Q-wave myocardial infarctions, significantly correlate with adverse outcomes.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) is a leading cause of death in the U.S., often asymptomatic in elderly individuals.
- Prognostic assessment is crucial for managing CAD in this population.
Purpose of the Study:
- To evaluate the prognostic value of exercise thallium-201 imaging in elderly patients with suspected or known CAD.
- To identify imaging predictors of hard cardiac events.
Main Methods:
- Prospective study of 449 elderly patients (mean age 65) undergoing exercise thallium-201 imaging.
- Follow-up for a median of 25 months to assess hard cardiac events (coronary revascularization, cardiac death, nonfatal acute myocardial infarction).
- Analysis of correlations between imaging findings and event rates.
Main Results:
- Abnormal exercise thallium-201 images were associated with a significantly higher rate of hard cardiac events (8% vs 1%, p < 0.002).
- Multi-vessel thallium-201 abnormality (13% vs 2%, p < 0.001) and Q-wave acute myocardial infarction (14% vs 3%, p < 0.001) predicted worse outcomes.
- The number of thallium-201 defects correlated with event occurrence (p < 0.002).
Conclusions:
- Exercise thallium-201 imaging is a valuable tool for risk stratification in elderly patients with CAD.
- Abnormalities in thallium-201 uptake, especially multi-vessel disease and Q-wave MI, indicate a higher risk of adverse cardiac events.
Abstract:
Although coronary artery disease (CAD) may be asymptomatic, it is the most common cause of death in elderly patients in the U.S. This study examined the prognosis of 449 patients with a mean age of 65 years using exercise thallium-201 imaging. At a follow-up of 25 months, 45 patients underwent coronary artery revascularization, 8 died of cardiac causes and 10 had nonfatal acute myocardial infarctions (AMIs). Thus the total of patients with "hard" events was 18. The events included 12 of 276 patients with atypical or non-anginal symptoms versus 6 of 128 with typical angina (p = not significant); 7 of 51 patients (14%) with Q-wave AMI versus 11 of 353 (3%) without Q-wave AMI (p less than 0.001); 1 of 183 patients (1%) with normal versus 17 of 221 (8%) with abnormal exercise thallium-201 images (p less than 0.002); 10 of 76 patients (13%) with multi vessel thallium-201 abnormality vs 8 of 328 (2%) with no or 1-vessel thallium-201 abnormality (p less than 0.001) and 10 of 96 patients (10%) with greater than or equal to 3 abnormal segments by thallium-201 imaging (total segments = 9) versus 8 of 308 patients with no or less than 3 abnormal segments (p less than 0.001). The number of segments with thallium-201 defects was 1 +/- 2 patients without and 3 +/- 2 in patients with hard events (p less than 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)