Prognostic importance of silent myocardial ischemia detected by intravenous dipyridamole thallium myocardial imaging in asymptomatic patients with coronary artery disease

Liwa T. Younis, Sheila Byers, Leslee Shaw, Grace Barth, Henry Goodgold, Bernard R. Chaitman

Research output: Contribution to journalArticlepeer-review

85 Scopus citations

Abstract

One hundred seven asymptomatic patients who underwent intravenous dipyridamole thallium imaging were evaluated to determine prognostic indicators of subsequent cardiac events over an average follow-up period of 14 ±10 months. Univariate analysis of 18 clinical, scintigraphic and angiographic variables revealed that a reversible thallium defect, a combined fixed and reversible thallium defect, number of segmental thallium defects and extent of coronary artery disease were significant predictors of subsequent cardiac events. Of the 13 patients who died or had a nonfatal infarction, 12 had a reversible thallium defect. Stepwise logistic regression analysis selected a reversible thallium defect as the only significant predictor of cardiac events. When death or myocardial infarction was the outcome variable, a combined fixed and reversible thallium defect was the only predictor of outcome. In patients without previous myocardial infarction, the cardiac event rate was significantly greater in those with an abnormal versus normal thallium scan (55% versus 12%, p < 0.001). Thus, intravenous dipyridamole thallium scintigraphy is a useful noninvasive test to risk stratify asymptomatic patients with coronary artery disease. A reversible thallium defect most likely indicates silent myocardial Ischemia in a sizable fraction of patients in this clinical subset and is associated with an unfavorable prognosis.

Original languageEnglish
Pages (from-to)1635-1641
Number of pages7
JournalJournal of the American College of Cardiology
Volume14
Issue number7
DOIs
StatePublished - Dec 1989
Externally publishedYes

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