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Determination of Extent and Location of Coronary Artery Disease in Patients Without Prior Myocardial Infarction by Thallium-201 Tomography with Pharmacologic Stress

Divisions of Nuclear Medicine and Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan

Correspondence: For reprints contact: Markus Schwaiger, MD, University of Michigan Medical Center B1G505, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0028.

ABSTRACT

Seventy-six patients undergoing pharmacologic stress ²⁰¹Tl tomography and coronary angiography within 14 ± 12 days were studied to determine how well coronary artery disease extent and location could be determined by this scintigraphic technique. No patient had prior myocardial infarction or revascularization. Scintigrams were scored visually and quantitatively. Angiographic lesions 50% were considered significant. Receiver operating characteristic curves were generated for the scintigrams against the angiographic gold standard. Predictive accuracies were determined and compared with the quantitative results. Predictive accuracy was 0.49 for visual and 0.58 for computer identification of single-vessel disease, 0.52 for both visual and computer identification of multi vessel disease, 0.64 for both in correctly localizing left anterior descending artery disease, 0.78 versus 0.70 for the right coronary artery and 0.72 versus 0.68 for the left circumflex artery. For the overall detection of disease, the predictive accuracies were 0.79 and 0.80. Although high diagnostic accuracy for detection of coronary artery disease by this approach has been previously documented, the assessment of extent of disease in patients without prior myocardial infarction appears limited.

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