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Imaging to justify no intervention

  • Christoph A. Nienaber
  • Gunnar K. Lund
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 173)

Abstract

“Words, words, words, I’m so sick of words”, said Eliza Doolittle, which could well refer to the number of articles on the merits of testing by use of the electrocardiogram (rest, exercise and dynamic), Tl-201 and Tc-99m-MIBI perfusion scans, the rest and stress echocardiogram (transthoracic and transesophageal), arterial calcification etc., and reports on the various advantages of specific stress interventions (pacing, pharmacologic, psychologic) to uncover evidence of ischemia and other physiologic or anatomic abnormalities. A literature review gives the impression that initial reports are later superseded by newer reports claiming superiority in aspects such as diagnostic and prognostic evaluation, and shows that many “successful” testing options first enthusiastically reported, are later criticized, then abandoned or replaced by the latest “fashion” in diagnostics or risk stratification.

Keywords

Coronary Artery Disease Coronary Flow Reserve Significant Coronary Artery Disease Coronary Artery Lesion Left Circumflex Coronary Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Gorry GA, Pauker SG, Schwartz WB. The diagnostic importance of the normal finding. N Engl J Med 1978; 298: 486–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Rifkin RD, Hood WB Jr. Bayesian analysis of electrocardiographic exercise stress testing. N Engl J Med 1977; 297: 681–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Ladenheim ML, Kotler TS, Pollock BH et al. Incremental prognostic power of exercise electrocardiography and myocardial perfusion scintigraphy in suspected coronary artery disease. Am J Cardiol 1987; 59: 270–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Varetto T, Cantalupi D, Alberto Alteieri A, Orlandi C. Emergency room Technetium–99m Sestamibi imaging to rule out acute myocardial ischemic events in patients with nondiagnostic electrocardiograms. J Am Coll Cardiol 1993; 22: 1804–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Grayboys TB, Bieglson B, Lambert S et al. Results of a second opinion trial among patients recommended for coronary arteriography. J Am Med Assoc 1992; 268: 2537–40.CrossRefGoogle Scholar
  6. 6.
    Fattah AA, Kamal AM, Pancholy S, Iskandrian AS. Prognostic implications of normal exercise tomographic thallium images in patients with angiographic evidence of significant coronary artery disease. Am J Cardiol 1994; 74:769–71.PubMedCrossRefGoogle Scholar
  7. 7.
    Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med 1979; 300: 1350–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Fortuin NJ, Weiss JL. Reviews of contemporary laboratory methods. Circulation 1977; 56: 699–712.PubMedGoogle Scholar
  9. 9.
    Melin JA, Piret LJ, Vanbutsele RJM et al. Diagnostic value of exercise electrocardiography and thallium myocardial scintigraphy in patients without previous myocardial infarction: A Bayesian approach. Circulation 1981; 63: 1019–24.PubMedCrossRefGoogle Scholar
  10. 10.
    Sivarajan Froelicher E. Usefulness of exercise testing shortly after acute myocardial infarction for predicting 10–year mortality. Am J Cardiol 1994; 74:318–23.CrossRefGoogle Scholar
  11. 11.
    Brown KA, Boucher CA, Okada RD et al. Prognostic value of exercise thallium-201 imaging in patients presenting for evaluation of chest pain. JACC 1983; 1: 994–1001.PubMedGoogle Scholar
  12. 12.
    Schwartz WB, Gorry GA, Kassirer JP et al. Decision analysis and clinical judgment. Am J Med 1973; 55: 459–72.PubMedCrossRefGoogle Scholar
  13. 13.
    Me Neil BJ, Keeler E, Adelstein SJ. Primer on certain elements of medical decision making. N Engl J Med 1975; 293: 211–5.CrossRefGoogle Scholar
  14. 14.
    Patton DD. Introduction to clinical decision making. Semin Nucl Med 1978; 8: 273–82.PubMedCrossRefGoogle Scholar
  15. 15.
    Dixon J, Margolis J. Accuracy of exercise tests: Role of patient selection. Circulation 1976; 54 (Suppl): 11–205.Google Scholar
  16. 16.
    Eagle KA, Coley CM, Newell JB et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med 1989; 110: 859–66.PubMedGoogle Scholar
  17. 17.
    Sox HC Jr, Littenberg B, Garber A. The Role of exercise testing in screening for coronary artery disease. Ann Intern Med 1989; 110: 456–69.PubMedGoogle Scholar
  18. 18.
    Weiner DA, Ryan TJ, McCabe CH et al. Exercise Stress Testing. Correlations among history of angina, ST-segment response and prevalence of coronary-artery-disease in the Coronary Artery Surgery Study (CASS). N Engl J Med 1979; 301: 230–5.PubMedCrossRefGoogle Scholar
  19. 19.
    O’Rourke RA. Clinical decisions for post-myocardial infarction patients. Mod Concepts Cardiovasc Dis 1986; 55: 55–60.Google Scholar
  20. 20.
    The Multicenter Post-Infarction Research Group. Risk stratification and survival after myocardial infarction. N Engl J Med 1983; 309: 331–9.CrossRefGoogle Scholar
  21. 21.
    Alderman EL, Bourassa MG, Cohen LS et al. Ten-year follow-up of survival and myocardial infarction in the Randomized Coronary Artery Surgery Study. Circulation 1990; 82: 1629–38.PubMedCrossRefGoogle Scholar
  22. 22.
    Myers WO, Davis K, Foster ED et al. Surgical survival in the Coronary Artery Surgery Study (CASS) Registry. Ann Thorac Surg 1985; 40: 246–301.CrossRefGoogle Scholar
  23. 23.
    Demer LL, Gould KL, Goldstein RA et al. Assessment of coronary artery disease severity by positron emission tomography: Comparison with quantitative arteriography in 193 patients. Circulation 1989; 79: 825–34.PubMedCrossRefGoogle Scholar
  24. 24.
    Parisi AF, Folland ED, Hartigan P. On behalf of the Veterans Affairs ACME Investigators. A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. N Engl J Med. 1992; 326:10–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Ellis SG, Fisher L, Dushman-Ellis S et al. Comparison of 3–5 year mortality and infarction rates after angioplasty (PTCA) or medical therapy for 1 or 2 vessel left anterior descending disease. Circulation 1987; 76: IV-392.Google Scholar
  26. 26.
    Little WC, Constantinescu M, Applegate RJ et al. Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation 1988; 78: 1157–63.PubMedCrossRefGoogle Scholar
  27. 27.
    Brooks N, Cattail M, Jennings K et al. Isolated disease of left anterior descending coronary artery: Angiographic and clinical study of 218 patients. Br Heart J 1987; 47: 71–8.CrossRefGoogle Scholar
  28. 28.
    Califf RM, Tomabechi Y, Lee K et al. Outcome in one vessel coronary artery disease. Circulation 1983; 67: 283–90.PubMedCrossRefGoogle Scholar
  29. 29.
    Kouchoukas NT, Oberman O, Russell RO et al. Surgical versus medical treatment of occlusive disease compared to the left anterior descending coronary artery. Am J Cardiol 1975; 35: 836–43.CrossRefGoogle Scholar
  30. 30.
    Topoi EJ, Ellis SG, Cosgrove DM et al. Analysis of coronary angioplasty practice in the United States with an insurance claims data base. Circulation 1993; 87: 1489–97.Google Scholar
  31. 31.
    DeBusk RF. Specialized testing after recent acute myocardial infarction. Ann Intern Med 1989; 110: 470–81.PubMedGoogle Scholar
  32. 32.
    Chatterjee K. Ischemia: Silent or manifest - does it matter? J Am Coll Cardiol 1989; 13: 1503–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Villanueva FS, Smith WH, Watson DD, Beller GA. ST-segment depression during dipyridamole infusion, and its clinical, scintigraphic and hemodynamic correlates. Am J Cardiol 1992; 69: 445–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Leppo JA, O’Brien J, Rothendler JA et al. Dipyridamole-thallium-201 scintigraphy in the prediction of future cardiac events after acute myocardial infarction. N Engl J Med 1984; 310: 1014–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Boucher CA, Brewster DC, Darling RC et al. Determination of cardiac risk by dipyridamo-le-thallium imaging before peripheral vascular surgery. N Engl J Med 1985; 312; 389–94.PubMedCrossRefGoogle Scholar
  36. 36.
    Bairey CN, Rozanski A, Maddahi J et al. Exercise Thallium-201 scintigraphy and prognosis in typical angina pectoris and negative exercise electrocardiography. Am J Cardiol 1989; 64: 282–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Pryor DB. The academic life cycle of a noninvasive test. Circulation 1990; 82: 302–4.PubMedCrossRefGoogle Scholar
  38. 38.
    Folland ED, Vogel RA, Hartigan P et al. and the Veterans Affairs ACME Investigators. Relation between coronary artery stenosis assessed by visual, caliper, and computer methods and exercise capacity in patients with single-vessel coronary artery disease. Circulation 1994; 89: 2005–14.PubMedGoogle Scholar
  39. 39.
    Uren NG, Melin JA, De Bruyne B et al. Relation between myocardial blood flow and the severity of coronary artery stenosis. N Engl J Med 1994; 330: 1782–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Miller DD, Donohue TJ, Younis LT et al. Correlation of pharmacological 99 mTC-sestamibi myocardial perfusion imaging with poststenotic coronary flow reserve in patients with angiographically intermediate coronary artery stenoses. Circulation 1994; 89: 2150–60.PubMedGoogle Scholar
  41. 41.
    Detre K, Holubkov R, Kelsery S et al. Percutaneous transluminal coronary angioplasty in 1985–1986 and 1977–1981: The National Heart, Lung and Blood Institute Registry. N Engl J Med 1988; 318: 256–61.CrossRefGoogle Scholar
  42. 42.
    Bourassa MG, Noble J. Complication rate of coronary arteriography: A review of 5250 cases studied by a percutaneous femoral technique. Circulation 1976; 53: 106–11.PubMedGoogle Scholar
  43. 43.
    Ingelfinger FJ. Decision in medicine. N Engl J Med 1975; 293: 254–5.PubMedCrossRefGoogle Scholar
  44. 44.
    Panter SG, Kopelman RI. Invasive interventions. N Engl J Med 1994; 331: 601–5.CrossRefGoogle Scholar
  45. 45.
    Kern MJ, Bach RG. Clinical problem-solving: Invasive interventions (Letter). N Engl J Med 1995; 332: 125.PubMedCrossRefGoogle Scholar
  46. 46.
    Kahn JK, McGhie I, Akers MS et al. Quantitative rotational tomography with Tl-201 and Tc-99m 2-methoxy-isobutyl-isonitrile: A direct comparison in normal individuals and patients with coronary artery disease. Circulation 1989; 79: 1282–93.PubMedCrossRefGoogle Scholar
  47. 47.
    Ritchie JL, Trobaugh GB, Hamilton GW et al. Myocardial imaging with thallium-201 at rest and during exercise: Comparison with coronary arteriography and stress electrocardiography. Circulation 1977; 56: 6672.Google Scholar
  48. 48.
    Botvinick EH, Taradash MR, Shames DM et al. Thallium-201 myocardial perfusion scintigraphy for the clinical clarification of normal, abnormal, and equivocal electrocardiographic stress tests. Am J Cardiol 1978; 41: 43–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Borer JS, Bacharach SL, Green MV et al. Real-time radionuclide cineangiography in the noninvasive evaluation of global and regional left ventricular function at rest and during exercise in patients with coronary artery disease. N Engl J Med 1977; 296: 839.PubMedCrossRefGoogle Scholar
  50. 50.
    Maddahi J, Garcia EV, Berman DS et al. Improved noninvasive assessment of coronary artery disease by quantitative analysis of regional stress myocardial distribution and washout of thallium-201. Circulation 1981; 64: 924–30.PubMedCrossRefGoogle Scholar
  51. 51.
    Berger BC, Watson DD, Taylor GJ et al. Quantitative thallium-201 exercise scintigraphy for detection of coronary artery disease. J Nucl Med 1981; 22: 585–92.PubMedGoogle Scholar
  52. 52.
    Tamaki N, Yonekura Y, MukaiT et al. Stress thallium-201 transaxial emission computed tomography: Quantitative versus qualitative analysis for evaluation of coronary artery disease. J Am Coll Cardiol 1984; 4: 1213–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Garcia EV, Van Train K, Maddahi J et al. Quantification of rotational thallium-201 myocardial tomography. J Nucl Med 1985; 26: 17–24.PubMedGoogle Scholar
  54. 54.
    Beller GA. Role of nuclear cardiology in evaluating the total ischemic burden in coronary artery disease. Am J Cardiol 1987; 59, 31C.PubMedCrossRefGoogle Scholar
  55. 55.
    Maddahi J, Kiat H, Van Train KF et al. Myocardial perfusion imaging with technetium-99m sestamibi SPECT in the evaluation of coronary artery disease. Am J Cardiol 1990; 66: 55E–62E.PubMedCrossRefGoogle Scholar
  56. 56.
    Stewart R, Schwaiger M, Molina E et al. Comparison of rubidium-82 positron emission tomography and thallium-201 SPECT imaging for detection of coronary artery disease. Am J Cardiol 1991; 67: 1303–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Tamaki N, Yonekura Y, Senda M et al. Value and limitation of stress thallium-201 single photon emission computed tomography: Comparison with nitrogen-13 positron tomography. J Nucl Med 1988; 29: 1181–8.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Christoph A. Nienaber
    • 1
  • Gunnar K. Lund
  1. 1.Department of CardiologyUniversity Hospital EppendorfHamburgGermany

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