Thallium-201 exercise testing in patients 6-8 weeks after myocardial infarction: limited value for the detection of multivessel disease.

In a clinical study, the value of exercise electrocardiography and thallium-201 scintigraphy was determined for the detection of multivessel disease in 176 patients 6-8 weeks after a first myocardial infarction. In all patients coronary arteriography was performed within 3 days after the non-invasive procedure. Of the 176 patients, 77 patients had multivessel disease (prevalence 44%). The exercise electrocardiogram was positive in 49 of these 77 patients (sensitivity 64%), while the thallium scintigram was positive in only 24 patients (sensitivity 31%). When the results of both procedures were added, a moderate sensitivity of 66% and a similar specificity of 62% was found; the positive and negative predictive values were 57% and 70%, respectively, and were considered too low for the adequate clinical diagnosis of multivessel disease after myocardial infarction. Based on our results, it is concluded that qualitative assessment of thallium exercise scintigraphy, alone or combined with electrocardiography, should not be used to predict the absence or presence of multivessel disease in patients after previous myocardial infarction.