STRESS TL-201 IMAGING AFTER CORONARY ANGIOPLASTY PREDICTS RESTENOSIS AND RECURRENT SYMPTOMS

[摘要] The predictive accuracy of thallium imaging for the diagnosis of restenosis after angioplasty was evaluated in 121 patients who had undergone a successful procedure. Patients were evaluated three times over a 1 year follow-up period for symptoms, electrocardiographic (ECG) changes during exercise and the presence of reversible ischemia on exercise thallium imaging. At initial evaluation (4 to 6 weeks after angioplasty), 104 patients (86%) were asymptomatic. Of the 17 patients with chest pain symptoms, 9 had reversible ischemia on thallium imaging and all had restenosis. Of the 104 asymptomatic patients, 26 (25%) had a positive thallium scan (reversible ischemia) and this sign identified a high risk group. Evidence of restenosis was present by 6 months in 22 (85%) and by 1 year in 25 (96%) of these 26 patients. The largest group of patients manifested symptoms by the second evaluation (between 3 and 6 months after angioplasty). Of 28 patients with symptoms and a positive thallium scan at this evaluation, 26 had restenosis; on initial evaluation, 22 of these 26 patients had no symptoms but had had a positive thallium study. Ten of the 65 patients in the asymptomatic group had a positive thallium scan, but the scans of this group were not as predictive for recurrent symptoms as were those of the same group at initial evaluation. The 74 patients who had a negative thallium scan at 3 to 6 months with or without associated symptoms had a low likelihood of developing restenosis or symptoms. By the 1 year evaluation, only five additional patients became symptomatic and four of those had previously been identified as having a positive thallium study. Nineteen patients continued to have chest pain symptoms with a negative thallium scan. Fifteen of these had repeat catheterization and only one had restenosis. In this clinical study, sequential thallium imaging provided an accurate prediction of which patients would develop restenosis and the time course it would follow. Thallium imaging identified high and low risk patients after angioplasty and was superior to symptoms or ECG changes in the evaluation of patients.

[发布日期] 1988-11-01