Prognostic utility of predischarge dipyridamole-thallium imaging compared to predischarge submaximal exercise electrocardiography and maximal exercise thallium imaging after uncomplicated acute myocardial infarction

Journal Article · Fri Dec 01 04:00:00 EST 1989 · American Journal of Cardiology; (USA)

DOI:https://doi.org/10.1016/0002-9149(89)90561-4· OSTI ID:5083652

Gimple, L W; Hutter, Jr, A M; Guiney, T E; Boucher, C A ^[1]

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1. Massachusetts General Hospital, Boston (USA)

The prognostic value of predischarge dipyridamole-thallium scanning after uncomplicated myocardial infarction was determined by comparison with submaximal exercise electrocardiography and 6-week maximal exercise thallium imaging and by correlation with clinical events. Two endpoints were defined: cardiac events and severe ischemic potential. Of the 40 patients studied, 8 had cardiac events within 6 months (1 died, 3 had myocardial infarction and 4 had unstable angina requiring hospitalization). The finding of any redistribution on dipyridamole-thallium scanning was common (77%) in these patients and had poor specificity (29%). Redistribution outside of the infarct zone, however, had equivalent sensitivity (63%) and better specificity (75%) for events (p less than 0.05). Both predischarge dipyridamole-thallium and submaximal exercise electrocardiography identified 5 of the 8 events (p = 0.04 and 0.07, respectively). The negative predictive accuracy for events for both dipyridamole-thallium and submaximal exercise electrocardiography was 88%. In addition to the 8 patients with events, 16 other patients had severe ischemic potential (6 had coronary bypass surgery, 1 had inoperable 3-vessel disease and 9 had markedly abnormal 6-week maximal exercise tests). Predischarge dipyridamole-thallium and submaximal exercise testing also identified 8 and 7 of these 16 patients with severe ischemic potential, respectively. Six of the 8 cardiac events occurred before 6-week follow-up. A maximal exercise thallium test at 6 weeks identified 1 of the 2 additional events within 6 months correctly. Thallium redistribution after dipyridamole in coronary territories outside the infarct zone is a sensitive and specific predictor of subsequent cardiac events and identifies patients with severe ischemic potential.

• OSTI ID: 5083652
• Journal Information: American Journal of Cardiology; (USA), Journal Name: American Journal of Cardiology; (USA) Vol. 64:19; ISSN AJCDA; ISSN 0002-9149
• Country of Publication: United States
• Language: English

Related Subjects

550601* -- Medicine-- Unsealed Radionuclides in Diagnostics
62 RADIOLOGY AND NUCLEAR MEDICINE
BODY
CARDIOVASCULAR AGENTS
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
COMPARATIVE EVALUATIONS
COUNTING TECHNIQUES
DIAGNOSIS
DIAGRAMS
DISEASES
DRUGS
ELECTROCARDIOGRAMS
EXERCISE
HEART
ISOTOPES
MYOCARDIAL INFARCTION
ORGANS
PATIENTS
RADIOISOTOPE SCANNING
SENSITIVITY ANALYSIS
SPECIFICITY
THALLIUM ISOTOPES
VASODILATORS