Key result
Large exercise thallium defects linked to significantly worse cardiac event-free survival in women.
Why the study?
The independent and incremental prognostic value of exercise thallium single-photon emission computed tomographic imaging in women undergoing coronary angiography was examined.
Cohort (n=212)
May refine risk stratification in women post-angiography; leaves open whether imaging alters management or outcomes.
BACKGROUND: This study examined the independent and incremental prognostic value of exercise thallium single-photon emission computed tomographic imaging in 212 women who also underwent coronary angiography. METHODS AND RESULTS: The left ventricular ejection fraction was normal (65% +/- 15%). During a mean follow-up of 40 months, 27 women had events (cardiac death or nonfatal myocardial infarction). Univariate Cox survival analysis showed several variables to be different between patients with events and those without events: age, exercise heart rate, the extent of coronary artery disease, reversible thallium defects, number of segments with reversible abnormality, and size of perfusion abnormality. Multivariate survival analysis showed that a large perfusion abnormality and age were the independent predictors of events. Actuarial life-table analysis showed that women with a large thallium abnormality (> or = 15% of the myocardium) had significantly worse event-free survival rates than had women with no or small abnormalities (Mantel-Cox statistic = 16; p = 0.0001). CONCLUSIONS: Thus exercise thallium-201 single-photon emission computed tomographic imaging provides independent and incremental prognostic information to clinical, exercise, and coronary angiographic results in women. The presence of a larger thallium abnormality identifies women at high risk of cardiac events.
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Pancholy et al. (1995) conducted a cohort in Coronary artery disease (n=212). Large exercise thallium perfusion abnormality (≥15% of the myocardium) vs. No or small thallium abnormalities was evaluated on Cardiac events (cardiac death or nonfatal myocardial infarction) (p=0.0001). Women with a large exercise thallium perfusion abnormality (≥15% of the myocardium) had significantly worse event-free survival for cardiac death or nonfatal MI than those without (P=0.0001).
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