Prognostic value of coronary angiography in patients with chronic ischemic left ventricular dysfunction and evidence of viable myocardium on thallium reinjection imaging

Mario Petretta, Alberto Cuocolo, Domenico Bonaduce, Emanuele Nicolai, Maria Lucia Vicario, Marco Salvatore

Research output: Contribution to journalArticlepeer-review

Abstract

Background. We evaluated the independent and incremental prognostic value of cardiac catheterization and coronary angiographic data over thallium reinjection after stress redistribution imaging in patients with myocardial infarction and left ventricular dysfunction. Methods and Results. Sixty-nine patients with a first myocardial infarction (> 8 weeks) and left ventricular ejection fraction ≤ 40% underwent thallium-201 reinjection after stress redistribution tomographic imaging and cardiac catheterization. During follow-up (mean 26 months) 11 cardiac events (8 cardiac deaths and 3 nonfatal myocardial infarctions) occurred. On Cox regression analysis independent predictors of cardiac events were the sum of reversible and moderately irreversible defects at thallium reinjection (χ2, 16.4, p <0.005) and the number of reversible defects at stress redistribution (χ2, 5.1, P <0.05). Moreover, thallium reinjection imaging improved the prognostic power of clinical, exercise, and stress redistribution data (p <0.01). The inclusion of left ventricular ejection fraction produced a borderline improvement p = 0.06), whereas the number of vessels with coronary disease did not. In contrast, in patients at high risk such as those with at least 25% of viable myocardium at reinjection, the number of diseased vessels provided additional prognostic information (p <0.05). Conclusions. In patients with chronic ischemic left ventricular dysfunction, left ventricular ejection fraction, but not the number of diseased vessels, provides additional prognostic information to thallium imaging. Therefore coronary angiography seems unnecessary in these patients, unless a significative amount of viable myocardium is detectable.

Original languageEnglish
Pages (from-to)387-395
Number of pages9
JournalJournal of Nuclear Cardiology
Volume4
Issue number5
DOIs
Publication statusPublished - Sep 1997

Keywords

  • Coronary artery disease
  • Myocardial infarction
  • Myocardial viability

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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