Thallium-201 myocardial scintigraphy in patients with triple-vessel disease and ischemic exercise stress tests

Thirty patents with triple-vessel coronary artery disease proven by angiography, symptomatic angina and a positive ECG stress test were evaluated with thallium-zol (²⁰¹T1) scintigraphy. Twenty patients also had aortocoronary saphenous vein bypass surgery; 15 of them had repeat noninvasive evaluation. Seventy percent of these patients showed ischemia by ²⁰¹Tl scintigraphy, of which one-half returned to normal after surgery. Postoperative reversion of the ECG stress test together with ²⁰¹Tl stress/reperfusion imaging correlated well with the completeness of surgical revascularization. We could not explain the prevalence (80%) of infarcts detected by ²⁰¹Tl in this group, of which 76% could be anatomically correlated to epicardial scars. The positivity of infarcts by ²⁰¹Tl exceeded that predicted by previous history of infarction, Q waves on resting ECG or ventriculographic akinesis. These observations suggest that ²⁰¹Tl scintigraphy is a useful noninvasive tool in the follow-up and understanding of patients with coronary heart disease. These conclusions also support the concept that ²⁰¹Tl stress imaging need not have the identical connotation as the ECG stress test.