An abnormal exercise thallium scan in asymptomatic siblings of patients with premature CHD was associated with an adjusted relative risk of 4.7 for developing future clinical CHD.
Cohort (n=264)
Does exercise thallium scintigraphy predict future clinical coronary heart disease in asymptomatic individuals with a sibling history of premature CHD?
Exercise thallium scintigraphy is a strong predictor of future clinical CHD in asymptomatic siblings of patients with premature CHD, particularly in men aged 45 years or older.
Effect estimate: RR 4.7
BACKGROUND: Exercise testing, even when combined with radionuclide perfusion imaging, does not accurately predict future clinical coronary heart disease (CHD) in low-risk asymptomatic populations. We hypothesized that these tests would perform better in a higher-risk population with a high prevalence of occult CHD. Siblings of persons with premature CHD represent such a group in whom it would be advantageous to identify affected individuals before the occurrence of clinically manifest CHD. METHODS AND RESULTS: Exercise thallium scintigraphy was performed in 264 asymptomatic individuals less than 60 years of age who had a sibling with documented CHD before age 60. Despite an average age of only 46 years at the time of screening, 19 of 264 siblings developed clinical CHD (sudden death in 1, myocardial infarction in 10, coronary revascularization in 8) over a mean of 6.2 years (range, 1 to 9 years) of follow-up. Abnormal thallium scans were observed in 29% of men and 9% of women, while abnormal exercise ECGs occurred in 12% and 5% respectively. Of men >/= 45 years of age, 45% had an abnormal exercise ECG, thallium scan, or both. In contrast, only 3% of women 45 years of age at the time of screening and had a strikingly high incidence of CHD (6 of 12, 50%). CONCLUSIONS: Exercise thallium scintigraphy appears to be useful in the risk assessment of asymptomatic siblings of patients with premature CHD, particularly in male siblings who are 45 years of age or older.
Blumenthal et al. (Fri,) conducted a cohort in Asymptomatic individuals with a family history of premature coronary heart disease (n=264). Exercise thallium scintigraphy vs. Normal scan was evaluated on Clinical coronary heart disease (sudden death, myocardial infarction, coronary revascularization) (RR 4.7). An abnormal exercise thallium scan in asymptomatic siblings of patients with premature CHD was associated with an adjusted relative risk of 4.7 for developing future clinical CHD.
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