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Prognostic significance of ST-segment depression during adenosine perfusion imaging.

Authors
Marshall, ES; Raichlen, JS; Kim, SM; Intenzo, CM; Sawyer, DT; Brody, EA; Tighe, DA; Park, CH
Citation
American heart journal, 130(1):58-66, 1995
Journal Title
American heart journal
ISSN
0002-87031097-6744
Abstract
To determine the significance of ST-segment depression during adenosine perfusion imaging for predicting future cardiac events, 188 patients with interpretable electrocardiograms were assessed 1 to 3 years (mean 21.5 +/- 6.6 months) after adenosine testing. At least 1 mm of ST-segment depression was observed in 32 (17%) patients, with > or = 2 mm of ST-segment depression in 10 (5.3%). Thirty-seven cardiac events occurred during the study period: 2 cardiac deaths, 5 nonfatal myocardial infarctions, 6 admissions for unstable angina, and 24 revascularizations. Univariate predictors of events were a history of congestive heart failure, previous non-Q-wave myocardial infarction, previous coronary angioplasty, use of antianginal medication, ST-segment depression during adenosine infusion (particularly > or = 2 mm), any reversible perfusion defect, transient left ventricular cavity dilation, and the severity of perfusion defects. Multivariate analysis identified > or = 2 mm ST-segment depression as the most significant predictor of cardiac events (relative risk [RR] = 6.5; p = 0.0001). Other independent predictors of events were left ventricular dilation (RR = 3.8; p = 0.002), previous coronary angioplasty (RR = 3.3; p = 0.001), a history of non-Q-wave myocardial infarction (RR = 2.3; p = 0.01), and the presence of any reversible defect (RR = 2.0; p = 0.05). We conclude that ST-segment depression occurs uncommonly during adenosine infusion, but the presence of > or = 2 mm of ST-segment depression is an independent predictor of future cardiac events and provides information in addition to that obtained from clinical variables and the results of adenosine perfusion imaging.
MeSH terms
Adenosine/administration & dosage/*diagnostic useAgedChi-Square DistributionCoronary Disease/diagnosisCoronary Vessels/radionuclide imagingElectrocardiography/*drug effects/methods/statistics & numerical dataExercise Test/methods/statistics & numerical dataFemaleFollow-Up StudiesHumansLikelihood FunctionsMaleMiddle AgedPrognosisProportional Hazards ModelsTechnetium Tc 99m Sestamibi/diagnostic useThallium Radioisotopes/diagnostic useTime Factors
PMID
7611124
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Nuclear Medicine & Molecular Imaging
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