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The Predictive Value of Myocardial Perfusion Scintigraphy after Stress in Patients without Previous Myocardial Infarction

Rush-Presbyterian-St. Luke's Medical Center and Rush Medical College, Chicago, Illinois

Correspondence: For reprints contact: David A. Turner, Dept. of Nuclear Medicine, Rush-Presbyterian-St. Luke's Medical Ctr., 1753 W. Congress Parkway, Chicago, IL 60612.

ABSTRACT

Seventy-five patients who had chest pain but no history or ECG evidence of myocardial infarction (MI) underwent myocardial-stress perfusion scintigraphy (MSPS) with thallium-201, treadmill-stress testing (TST), and coronary cineangiography (CA). The sensitivities of MSPS and TST for coronary stenosis 75% were 68% and 71%, respectively; their specificities were 97% and 79%, respectively (0.1 > p > 0.05). When the character of a patient's chest pain is considered, Bayesian analysis leads to the following conclusions: (a) MSPS can be useful in pre-CA screening of patients with chest pain but no MI if their pain is thought to be of uncertain or nonischemic origin; (b) the sensitivity of Tl-201 MSPS is not sufficient for pre-CA screening of patients without MI who have typical or atypical angina pectoris; (c) the sensitivity of MSPS would have to be approximately 95% in order for the test to be useful in pre-CA screening of patients who have atypical angina pectoris; (d) MSPS may be superior to TST in these applications; and (e) it is not clear that there is any advantage in combining MSPS and TST into a single screening test rather than using MSPS alone.