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ARTICLE |

Noninvasive Testing for Silent Myocardial Ischemia in Stable Coronary Patients FREE

Jeffrey A. Leppo, MD; Abdulmassih Iskandrian, MD; Kenneth A. Brown, MD; Mario S. Verani, MD
[+] Author Affiliations

Edited by Drummond Rennie, MD, Deputy Editor (West), and Margaret A. Winker, MD, Senior Editor.


JAMA. 1993;270(15):1809-1809. doi:10.1001/jama.1993.03510150043013
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To the Editor.  —Moss et al1 conclude that noninvasive testing is not useful in stable patients after a coronary event for identifying those at future risk for recurrent cardiac events. This conclusion is drawn from test results in a highly selected group of patients, and we would like to make the following comments, with respect to thallium-201 perfusion stress scintigraphy.It is important to note that the original goal of the Multicenter Study of Silent Myocardial Ischemia was to assess the prognostic significance of silent and symptomatic myocardial ischemia in patients with stable coronary artery disease. Therefore, one should be cautious in drawing any conclusions when the study goal is changed after patient enrollment is completed. Had Moss et al wished to assess the utility of various noninvasive testing methods to predict future cardiac events, the study design should have been altered and a much larger number of patients

REFERENCES

Moss AJ, Goldstein RE, Hall WJ, et al.  Detection and significance of myocardial ischemia in stable patients after recovery from an acute coronary event. JAMA . 1993;;269:2379-2385.
Diamond GA.  Postinfarction risk stratification: is preventive war winnable? JAMA . 1993;;269:2418-2419.
Gibson RS, Watson DD, Craddock GB, et al.  Prediction of cardiac events after uncomplicated myocardial infarction: a prospective study comparing predischarge exercise thallium-201 scintigraphy and coronary angiography. Circulation . 1983;;68: 321-336.
Kaul S, Lilly DR, Gascho JA, et al.  Prognostic utility of exercise thallium-201 test in ambulatory patients with chest pain: comparison with cardiac catheterization. Circulation . 1988;;77:745-748.
Leppo JA, O'Brien J, Rothendler JA, Getchell JD, Lee VW.  Dipyridamole-thallium-201 scintigraphy in the prediction of future cardiac events after acute myocardial infarction. N Engl J Med . 1984;;310:1014-1018.
Schwartz R, Benhorin J, Moss A, Bodenheimer M, Wackers F. Quantitative planar thallium-201 scintigraphy and cardiac death following recovery from an acute coronary event. Presented at First International Congress of Nuclear Cardiology; April 26, 1993; Cannes, France.

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Moss AJ, Goldstein RE, Hall WJ, et al.  Detection and significance of myocardial ischemia in stable patients after recovery from an acute coronary event. JAMA . 1993;;269:2379-2385.
Diamond GA.  Postinfarction risk stratification: is preventive war winnable? JAMA . 1993;;269:2418-2419.
Gibson RS, Watson DD, Craddock GB, et al.  Prediction of cardiac events after uncomplicated myocardial infarction: a prospective study comparing predischarge exercise thallium-201 scintigraphy and coronary angiography. Circulation . 1983;;68: 321-336.
Kaul S, Lilly DR, Gascho JA, et al.  Prognostic utility of exercise thallium-201 test in ambulatory patients with chest pain: comparison with cardiac catheterization. Circulation . 1988;;77:745-748.
Leppo JA, O'Brien J, Rothendler JA, Getchell JD, Lee VW.  Dipyridamole-thallium-201 scintigraphy in the prediction of future cardiac events after acute myocardial infarction. N Engl J Med . 1984;;310:1014-1018.
Schwartz R, Benhorin J, Moss A, Bodenheimer M, Wackers F. Quantitative planar thallium-201 scintigraphy and cardiac death following recovery from an acute coronary event. Presented at First International Congress of Nuclear Cardiology; April 26, 1993; Cannes, France.
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