Evaluation of Exercise Thallium Scintigraphy Versus Exercise Electrocardiography in Predicting Survival Outcomes and Morbid Cardiac Events in Patients With Single- And Double-Vessel Disease. Findings From the Angioplasty Compared to Medicine (ACME) Study

J Am Coll Cardiol. 1997 Nov 1;30(5):1256-63. doi: 10.1016/s0735-1097(97)00293-3.


Objectives: We sought to evaluate the prognostic ability of cardiac exercise stress tests in predicting cardiac mortality and morbidity in a low risk group of patients with established coronary artery disease (CAD).

Background: Although previous studies have demonstrated the superior value of stress nuclear cardiac scintigraphy in the prognosis of patients with CAD, none of these studies have focused on patients with a proven angiographic low risk profile (i.e., single- and double-vessel CAD).

Methods: Three hundred twenty-eight patients with documented single- and double-vessel disease were treated by random assignment to percutaneous transluminal coronary angioplasty or medical therapy in the Angioplasty Compared to Medicine (ACME) trial. Six months after randomization, maximal symptom-limited exercise tests were performed with electrocardiography (n = 300) and thallium scintigraphy (n = 270). Patients were followed up for a minimum of 5 years thereafter.

Results: A reversible thallium perfusion deficit documented after 6 months of either therapy was associated with an adverse mortality outcome (18% mortality rate with a reversible thallium perfusion defect and 8% mortality rate with no reversible thallium perfusion deficit, p = 0.02). Moreover, an important mortality gradient was demonstrated in relation to the number of reperfusing defects (0 = 7%, 1 to 2 = 15%, >3 = 20%, p = 0.04). Exercise electrocardiography did not predict this mortality outcome.

Conclusions: A reversible thallium perfusion deficit demonstrated 6 months after medical therapy or coronary angioplasty is a valuable prognostic marker in patients with angiographically documented single- and double-vessel disease and is superior to exercise electrocardiography in this regard.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Angina Pectoris / therapy
  • Angioplasty, Balloon, Coronary
  • Coronary Angiography
  • Coronary Disease / drug therapy
  • Coronary Disease / mortality*
  • Coronary Disease / therapy
  • Electrocardiography*
  • Exercise Test
  • Heart / diagnostic imaging
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Radionuclide Imaging
  • Stroke Volume
  • Survival Analysis
  • Thallium Radioisotopes*


  • Thallium Radioisotopes