Coronary Artery DiseaseLong-term prognostic value of duke treadmill score and exercise thallium-201 imaging performed one to three years after percutaneous transluminal coronary angioplasty
Section snippets
Study group
The study population was retrospectively identified from the Mayo Clinic Nuclear Cardiology Laboratory database and the Mayo Clinic PTCA Registry. Patients were eligible for the study if they: (1) performed an exercise tomographic Tl-201 test between January 1, 1989, through December 31, 1991, and (2) had undergone PTCA between 1 and 3 years preceding the Tl-201 study. Patients were excluded for the following reasons: (1) technically poor images; (2) left bundle branch block or paced
Exercise Tl-201 imaging (Table II)
The mean Duke score was 5 ± 6; 125 (60%) of the study group had a low-risk Duke score and 81 (39%) had normal Tl-201 images. Most patients had evidence of exercise-induced ischemia: 84 (40%) developed angina or had a positive electrocardiogram, and 114 (54%) had at least 1 reversible Tl-201 segment. The mean summed stress score was 50 and the mean summed reversibility score was 3. Exercise Tl-201 variables associated with a very poor prognosis were present in relatively few patients. Only 1%
Long-term event rate after PTCA
The low event rates in this study were comparable to other series of PTCA patients,6, 7, 8 indicating that patients post-PTCA generally are a low-risk population. Seventy-three percent of the study population had 1- or 2-vessel disease, similar to anatomic findings in large PTCA series.5, 6, 7, 8, 9
Follow-up of patients after PTCA
Standard treadmill testing early after PTCA for purposes of identifying restenosis is of limited usefulness due to low sensitivity and inability to localize ischemia.22 The Duke score was derived
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2005, American Heart JournalCitation Excerpt :Exercise variables had incremental value to clinical variables alone, and nuclear data improved the predictive power of the model further. Several groups have shown that myocardial perfusion defects after balloon angioplasty predict future ischemic events,21-23 including MI or cardiac death. In a study of stress MPI after coronary stenting, Cottin et al24 found a significant relationship between perfusion defects and subsequent MI, cardiovascular death, and repeat revascularization.