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Identification of high-risk patients with left main and three-vessel coronary artery disease by adenosine-single
A S Iskandrian1, J Heo, J Lemlek
1Philadelphia Heart Institute, Presbyterian Medical Center, PA 19104.
Insights
SPECT imaging with thallium-201 effectively identifies high-risk patients with left main or three-vessel coronary artery disease (CAD). Multivessel thallium abnormality, lung uptake, and ST depression predict significant CAD.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) remains a leading cause of mortality.
- Accurate identification of high-risk patients with left main or three-vessel CAD is crucial for timely intervention.
- SPECT imaging offers a non-invasive method for assessing myocardial perfusion.
Purpose of the Study:
- To evaluate the efficacy of SPECT imaging using thallium-201 during adenosine-induced coronary hyperemia.
- To determine the ability of this imaging technique to detect patients with high-risk CAD, specifically left main or three-vessel disease.
Main Methods:
- A study involving 339 patients, categorized into high-risk (left main or three-vessel CAD) and lower-risk groups.
- Univariate and stepwise discriminant analyses were performed on clinical and imaging variables.
- Key variables analyzed included myocardial infarction, ST segment depression, and thallium-201 SPECT findings.
Main Results:
- Multivessel thallium abnormality, increased lung thallium uptake, and ST depression were identified as significant predictors of high-risk CAD.
- These three variables allowed for the stratification of patients into groups with distinct prevalence rates of left main and three-vessel CAD (63%, 30%, and 13%).
Conclusions:
- SPECT imaging with thallium-201 during adenosine stress is a valuable tool for detecting high-risk CAD.
- The combination of multivessel thallium abnormality, lung uptake, and ST depression can accurately identify patients requiring aggressive management.
Abstract:
The purpose of this study was to examine the ability of SPECT imaging with thallium-201 during adenosine-induced coronary hyperemia to detect high-risk patients with left main or three-vessel CAD. There were 339 patients: 102 with either left main or three-vessel CAD (group 1) and 237 with no CAD, one-, or two-vessel disease (group 2). By means of univariate analysis, several variables were found to differ between groups 1 and 2: Q wave myocardial infarction (35% vs 25%, p < 0.05), ST segment depression (35% vs 19%, p < 0.001), age (67 +/- 9 vs 62 +/- 10 years, p < 0.001), resting systolic blood pressure (142 +/- 22 vs 135 +/- 20 mm Hg, p < 0.01), abnormal thallium images (95% vs 74%, p < 0.0001), multivessel thallium abnormality (76% vs 39%, p < 0.0001), extent of thallium abnormality (24 +/- 11% vs 19 +/- 13%, p < 0.0001), and increased lung thallium uptake (39% vs 15%, p < 0.01). According to stepwise discriminant analysis, only three variables were predictors of high risk: multivessel thallium abnormality (chi 2 = 27), increased lung thallium uptake (chi 2 = 10), and ST depression (chi 2 = 5). On the basis of these variables, patients were divided into three groups with different prevalence rates for left main and three-vessel CAD: 63% in 68 patients, 30% in 137 patients, and 13% in 137 patients.(ABSTRACT TRUNCATED AT 250 WORDS)