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, D. Douglas Miller

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58 Scopus citations

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 - Jun 1992
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Shaw, L., Chaitman, B. R., Hilton, T. C., Stocke, K., Younis, L. T., Caralis, D. G., Kong, B. A., & Miller, D. D. (1992). Prognostic value of dipyridamole thallium-201 imaging in elderly patients. Journal of the American College of Cardiology, 19(7), 1390-1398. https://doi.org/10.1016/0735-1097(92)90592-B