TY - JOUR
T1 - Prognostic value of exercise radionuclide angiography in a population-based cohort of patients with known or suspected coronary artery disease
AU - Iqbal, Amjad
AU - Gibbons, Raymond J.
AU - Zinsmeister, Alan R.
AU - Mock, Michael B.
AU - Ballard, David J.
PY - 1994/7/15
Y1 - 1994/7/15
N2 - Five hundred thirty-six residents of Olmsted County, Minnesota, who underwent supine rest and exercise radionuclide angiography because of known or suspected coronary artery disease, were followed for a median of 46 months to determine the prognostic value of exercise radionuclide angiography in a community population who generally did not undergo coronary angiography. There were 71 persons who experienced a new cardiac event (the initial events were cardiac death and nonfatal myocardial infarction in 26 and 45 persons, respectively). A proportional-hazards model identified 4 independent predictors of cardiac events: exercise ejection fraction (p < 0.001), exercise heart rate (p < 0.001), history of myocardial infarction (p = 0.01), and age (p = 0.04). Four-year infarct-free survival was 98% for the 152 patients with a peak exercise heart rate at or above the median (122 beats/min) and an exercise ejection fraction at or above the median (0.58). In the 150 patients with a peak exercise heart rate <122 beats/min and an exercise ejection fraction <0.58, 4-year infarct-free survival was 68%. When this population-based cohort was compared with a referral case series previously reported from our institution, these population-based patients were significantly more likely to be men, to have typical angina, to have higher exercise heart rates and exercise ejection fractions, and were less likely to be receiving β-receptor antagonist therapy. At each level of exercise ejection fraction, the population-based patients had a slightly but insignificantly greater risk than referral patients for subsequent cardiac events. These population-based data provide strong evidence of the prognostic value of exercise radionuclide angiography in community practice.
AB - Five hundred thirty-six residents of Olmsted County, Minnesota, who underwent supine rest and exercise radionuclide angiography because of known or suspected coronary artery disease, were followed for a median of 46 months to determine the prognostic value of exercise radionuclide angiography in a community population who generally did not undergo coronary angiography. There were 71 persons who experienced a new cardiac event (the initial events were cardiac death and nonfatal myocardial infarction in 26 and 45 persons, respectively). A proportional-hazards model identified 4 independent predictors of cardiac events: exercise ejection fraction (p < 0.001), exercise heart rate (p < 0.001), history of myocardial infarction (p = 0.01), and age (p = 0.04). Four-year infarct-free survival was 98% for the 152 patients with a peak exercise heart rate at or above the median (122 beats/min) and an exercise ejection fraction at or above the median (0.58). In the 150 patients with a peak exercise heart rate <122 beats/min and an exercise ejection fraction <0.58, 4-year infarct-free survival was 68%. When this population-based cohort was compared with a referral case series previously reported from our institution, these population-based patients were significantly more likely to be men, to have typical angina, to have higher exercise heart rates and exercise ejection fractions, and were less likely to be receiving β-receptor antagonist therapy. At each level of exercise ejection fraction, the population-based patients had a slightly but insignificantly greater risk than referral patients for subsequent cardiac events. These population-based data provide strong evidence of the prognostic value of exercise radionuclide angiography in community practice.
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U2 - 10.1016/0002-9149(94)90083-3
DO - 10.1016/0002-9149(94)90083-3
M3 - Article
C2 - 8023774
AN - SCOPUS:0028306390
VL - 74
SP - 119
EP - 124
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 2
ER -