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.
N1 - Funding Information:
From the Department of Internal Medicine, the Division of Cardiovascular Diseases and Internal Medicine, and the Department of Health Sciences Research, Section of Biostatistics, and Section of Clinical Epidemiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota. This study was supported in part by Research Grants AR30582 and HE24326 from the National Institutes of Health, Bethesda, Maryland. Dr. Ballard is supported in part by a career development award from the Merck Sharp & Dohme/Society for Epidemiologic Research Clinical Epidemiology Fellowship Program, West Point, Pennsylvania. Manuscript received August 12, 1993; revised manuscript received and accepted December 2 1, 1993.
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
SN - 0002-9149
VL - 74
SP - 119
EP - 124
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 2
ER -