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European Heart Journal 1983 4(9):622-631;
Copyright © 1983 by the European Society of Cardiology.
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© 1983, by the European Society of Cardiology

Bayesian analysis of stress thallium scintigraphy for the detection of multivessel coronary disease

J. A. MELIN, L. J. PIRET, R. J. M. VANBUTSELE, J. COSYNS, M. F. ROUSSEAU and J.-M. R. DETRY

Division of Cardiology and the Centre for Nuclear Medicine, University of Louvain Medical School Belgium

Received 10 June 1982; revised 26 November 1982; .

Address for correspondence and reprints: Professor J.-M. R. Detry. Division of Cardiology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10. B-1200 Brussels, Belgium.

Abstract

This study was performed in 224 men to determine the respective contribution of history and thallium-201 stress myocardial scintigraphic imaging in the non-invasive prediction of the severity of coronary disease.

Myocardial scintigraphic imaging had the better diagnostic accuracy (80%) for the detection of multivessel disease but the results emphasize the importance of the history in predicting the extent of coronary artery disease.

In patients with myocardial infarction, the diagnostic accuracy of the history (80%) was similar to the diagnostic accuracy of myocardial scintigraphic imaging (79%), in the subgroup of patients with residual angina pectoris after infarction, the accuracy of the history was even greater (87%) than that of myocardial scintigraphic imaging (78%). Thus, after myocardial infarction, scintigraphy was useful only in the small subgroup of patients without residual angina pectoris when it had a diagnostic accuracy of 79%, slightly but insignificantly superior to that of the history (62%). In patients without previous myocardial infarction, but with typical angina, myocardial scintigraphy was clearly superior to the simple history (diagnostic accuracy of 78% versus 53%; P < 0.001). In patients without myocardial infarction and with atypical angina the prevalence of multivessel disease was low (17%) and the diagnostic accuracy of history (83%) was barely different from the diagnostic accuracy of myocardial scintigraphic imaging (90%). Thus, when the likelihood of multivessel disease is very high (angina pectoris post myocardial infarction), or very low (atypical angina), the contribution of exercise testing is very limited. Important additional information is provided by maximal exercise testing and myocardial scintigraphic imaging only in the groups with an intermediate prevalence of multivessel disease, namely in the asymptomatic patients after myocardial infarction and in the patients with typical angina but no previous myocardial infarction.

Key Words: Coronary artery disease • exercise testing • thallium-201 • scintigraphy


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