Prognostic value of dipyridamole thallium-201 imaging in elderly patients

Leslee Shaw, Bernard R. Chaitman, Thomas C. Hilton, Karen Stocke, Liwa T. Younis, Dennis G. Caralis, Barbara A. Kong, Donald D Miller

Research output: Contribution to journalArticle

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Abstract

The prognostic value of intravenous dipyridamole myocardial perfusion imaging has not been studied in a large series of elderly patients. Patients ≥70 years of age with known or suspected coronary artery disease were evaluated to determine the predictive value of intravenous dipyridamole thallium-201 imaging for subsequent cardiac death or nonfatal myocardial infarction. Of the 348 patients, 207 were symptomatic and 141 were asymptomatic; 52% of the asymptomatic group had documented coronary artery disease. During 23 ± 15 months of follow-up, there were 52 cardiac deaths, 24 nonfatal myocardial infarctions and 42 revascularization procedures (percutaneous transluminal coronary angioplasty in 20; coronary artery bypass surgery in 22). Clinical univariate predictors of a cardiac event included previous myocardial infarction, congestive heart failure symptoms, hypercholesterolemia and diabetes (all p < 0.05). The presence of a fixed, reversible or combined thallium-201 defect was significantly associated with the occurrence of cardiac death or myocardial infarction during follow-up (p < 0.05). Cardiac death or nonfatal myocardial infarction occurred in only 7 (5%) of 150 patients with a normal dipyridamole thallium-201 study (p < 0.001). Stepwise logistic regression analysis of clinical and radionuclide variables revealed that an abnormal (reversible or fixed) dipyridamole thallium-201 study was the single best predictor of cardiac events (relative risk 7.2, p < 0.001). As has been demonstrated in younger patients, previous myocardial infarction (relative risk 1.8, p < 0.001) and symptoms of congestive heart failure at presentation (relative risk 1.6, p = 0.02) were also significant independent clinical predictors of cardiac death or myocardial infarction. Dipyridamole thallium-201 myocardial imaging is a powerful independent noninvasive technique for prognostication in the elderly, a group with limited exercise capacity, the potential for advanced coronary artery disease and a high risk for cardiac events.

Original languageEnglish (US)
Pages (from-to)1390-1398
Number of pages9
JournalJournal of the American College of Cardiology
Volume19
Issue number7
DOIs
StatePublished - Jan 1 1992
Externally publishedYes

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Dipyridamole
Thallium
Myocardial Infarction
Coronary Artery Disease
Heart Failure
Myocardial Perfusion Imaging
Coronary Balloon Angioplasty
Hypercholesterolemia
Coronary Artery Bypass
Radioisotopes
Logistic Models
Regression Analysis
Exercise

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic value of dipyridamole thallium-201 imaging in elderly patients. / Shaw, Leslee; Chaitman, Bernard R.; Hilton, Thomas C.; Stocke, Karen; Younis, Liwa T.; Caralis, Dennis G.; Kong, Barbara A.; Miller, Donald D.

In: Journal of the American College of Cardiology, Vol. 19, No. 7, 01.01.1992, p. 1390-1398.

Research output: Contribution to journalArticle

Shaw, L, Chaitman, BR, Hilton, TC, Stocke, K, Younis, LT, Caralis, DG, Kong, BA & Miller, DD 1992, 'Prognostic value of dipyridamole thallium-201 imaging in elderly patients', Journal of the American College of Cardiology, vol. 19, no. 7, pp. 1390-1398. https://doi.org/10.1016/0735-1097(92)90592-B
Shaw, Leslee ; Chaitman, Bernard R. ; Hilton, Thomas C. ; Stocke, Karen ; Younis, Liwa T. ; Caralis, Dennis G. ; Kong, Barbara A. ; Miller, Donald D. / Prognostic value of dipyridamole thallium-201 imaging in elderly patients. In: Journal of the American College of Cardiology. 1992 ; Vol. 19, No. 7. pp. 1390-1398.
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