The predictive accuracy of exercise thallium-201 (201Tl) myocardial scintigraphy in the evaluation of aortocoronary bypass graft surgery was assessed in 48 patients undergoing angiographic investigation 15 months (mean time) after myocardial revascularisation. 201Tl scintigrams detected 61 out of 77 (79%) patent grafts but only 21 out of 42 (50%) occluded grafts, though, for grafts supplying non-infarcted myocardium, the predictive accuracy of graft patency and graft occlusion was 85 per cent and 81 per cent, respectively. Stress electrocardiography failed to detect 15 out of 21 patients with scintigraphic evidence of regional myocardial ischaemia. Residual ischaemia in the proximal left anterior descending coronary distribution was commonly detected in 201Tl scintigrams despite a patent, well-functioning left anterior descending graft to the distal coronary segment. Additional residual ischaemia attributable to ungrafted coronary disease was detected by scintigraphy in 32 (67%) patients and most commonly occurred in the distribution of the diagonal branch of the left anterior descending especially in the presence of a patent distal left anterior descending graft. Thus, independent grafts to the diagonal branch of the left anterior descending are recommended at the time of aortocoronary bypass graft surgery.
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