Impact of thallium‐201 imaging on clinical assessment and management of patients with chest pain

Abstract

Summary:The histories, rest, and exercise ECG results of 60 patients without myocardial infarction complaining of chest pain were submitted to 6 physicians (3 cardiologists and 3 noncardiologists) who were unaware of the angiographic findings. The physicians were requested to estimate the probability of coronary artery disease present in percentages and to assess the need for coronary angiography on a five-point scale (1 = definitely not indicated, 5 = definitely indicated). After obtaining the results of thallium-20 1 imaging following dipyridamole (0.50 mg/kg intravenously) administration, the physicians were again requested to estimate probability and need for angiography. In the 43 patients with coronary artery disease the judgment of probability was increased significantly after 201T1 from 75.6&20.2% to 82.9&23.2% (p<O.OOl) and the need for angiography from 4.3&0.9% to 4.5&0.9% (p<O.OOl). In the subgroup of patients with atypical angina the relative change in probability was higher than in other subgroups of patients with coronary artery disease. In the 17 patients with normal coronary arteries the probability estimation fell after 201T1 from 36.7*22.0% to 24.8&21.0% (p<O.OOl), the need for angiography wasdecreased from2.7f1.1% to2.2+1.2% (p <0.001). With the zotTl information, cardiologists performed a better diagnostic differentiation of patients with and without coronary artery disease than noncardiologists. The study demonstrates the improvement of clinical diagnosis in patients with chest pain by thallium-201 imaging and confirms the favorable influence of the method on the management of the patients in terms of indications for coronary angiography.