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PREDICTING CARDIAC EVENTS AFTER THROMBOLYSIS.

Exercise testing is a useful tool for predicting prognosis after myocardial infarction. However, some studies have shown it to be less effective in patients given thrombolytic therapy. This prospective trial compared the value of exercise electrocardiography (EECG) and thallium-201 imaging for predicting cardiac events in 100 patients who had received thrombolytic therapy after MI and remained stable 6 weeks later. A total of 147 patients were originally identified as candidates for the study, but 47 were excluded because they were either too ill to be tested or had a cardiac event during the 6 weeks after thrombolysis.

All patients underwent both EECG and thallium imaging, and were then followed for 8 to 32 months. During this time 37 patients had cardiac events. EECG had a sensitivity of 35 percent for detecting cardiac events and a specificity of 68 percent, compared to 89 and 44 percent for thallium imaging. The positive predictive value for EECG was 39 percent and for thallium imaging was 49 percent; the corresponding negative predictive values were 64 and 88 percent.

Comment: The key finding in this study is that EECG testing was a poor predictor of cardiac events in patients who have received thrombolysis. Another interesting result is that a negative thallium study was a fairly good predictor of no adverse events.

— KI Marton

Published in Journal Watch General Medicine November 15, 1996

Citation(s):

Basu S et al. Value of thallium-201 imaging in detecting adverse cardiac events after myocardial infarction and thrombolysis: a follow up of 100 consecutive patients. BMJ 1996 Oct 5 313 844 -848.

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