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Value of thallium-201 imaging in detecting adverse cardiac events after myocardial infarction and thrombolysis: a follow up of 100 consecutive patients

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7061.844 (Published 05 October 1996) Cite this as: BMJ 1996;313:844
  1. Sumit Basu, research registrara,
  2. Roxy Senior, consultant cardiologista,
  3. Caroline Dore, statisticianb,
  4. Avijit Lahiri, consultant cardiologista
  1. a Department of Cardiac Research, Northwick Park Hospital and Institute for Medical Research, Harrow, Middlesex HA1 3UJ,
  2. b Medical Statistics Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London
  1. Correspondence to: Dr Lahiri.
  • Accepted 18 July 1996

Abstract

Objective: To determine the prognostic role of thallium-201 imaging compared with that of exercise electrocardiography in patients with acute myocardial infarction treated by thrombolysis.

Design: Patients who remained free of adverse cardiac events six weeks after myocardial infarction had stress and rest 201Tl imaging and exercise electrocardiography and were followed up for 8–32 months. Adverse cardiac events (death, reinfarction, unstable angina, and congestive heart failure) were documented.

Setting: Large district general hospital, Middlesex.

Subjects: 100 consecutive male and female patients who were stable six weeks after thrombolysis for myocardial infarction.

Main outcome measures: Prediction of occurrence of adverse cardiac events after myocardial infarction by exercise cardiography and 201Tl myocardial perfusion imaging.

Results: Reversible ischaemia on 201Tl imaging predicted adverse cardiac events in 33 out of 37 patients with such events during follow up (hazard ratio 8.1 (95% confidence interval 2.7 to 23.8), P<0.001). Exercise electrocardiography showed reversible ischaemia in 33 patients, of whom 13 had subsequent events, and failed to predict events in 24 patients (hazard ratio 1.1 (0.56 to 2.2), P = 0.8).

Conclusion: 201Tl imaging is a sensitive predictor of subsequent adverse cardiac events in patients who have received thrombolysis after acute myocardial infarction, whereas exercise electrocardiography fails to predict outcome.

Key messages

  • Exercise electrocardiography is a poor predictor of such events

  • Presence of reversible ischaemia on 201Tl imaging identifies 89% of patients who subsequently have such events

Footnotes

  • Funding This study has been funded by Northwick Park Hospital Cardiac Research Fund (charity No 287876).

  • Conflict of interest None.

  • Accepted 18 July 1996
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