The clinical role of thallium-201 scintigraphy in the management and prognosis of coronary artery disease.

The clinical impact of thallium-201 (Tl-201) scintigraphy in coronary artery disease was reviewed in 162 consecutive patients referred for routine investigation. Normal Tl-201 images were obtained in 86 of the 102 studies undertaken for diagnostic purposes. Eighty-one (94%) of the 86 were spared diagnostic coronary arteriography; 5 proceeded to coronary arteriography for persistent symptoms (1 had double vessel disease, 2 had single vessel disease only, 2 had normal arteriograms). Conversely, coronary arteriography was normal in 2 of 16 patients (12.5%) with unequivocal image defects. Tl-201 scintigraphy was performed as a functional complement to coronary arteriography in 60 patients, influencing the decision for surgery in 36 and determining the presence or absence of myocardial ischaemia in 24 patients with equivocal coronary arteriograms. Normal data were obtained in 9 patients. Of the 95 patients with normal Tl-201 scintigrams, only 5 (5.2%) required further investigations or intervention (4 arteriograms, 1 coronary angioplasty) over a follow-up period of 18 +/- 1 months, none suffered myocardial infarction and none died. There were no deaths in either the diagnostic or complementary group, irrespective of the result of the Tl-201 scintigram, during the mean follow-up period of 18 months. These data confirm both the valuable role of Tl-201 scintigraphy in the management of patients with suspected or proven coronary artery disease and the excellent prognostic value of a normal Tl-201 scintigram.