Comparison of rest and exercise radionuclide angiocardiography and exercise treadmill testing for diagnosis of anatomically extensive coronary artery disease.

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Abstract
The accuracy of rest and exercise radionuclide angiogcardiography (RNA) and exercise treadmill testing (ETT) for diagnosis of 3-vessel or left main coronary artery disease (extensive CAD) was determined in 544 patients. ETT and RNA sensitivities were similar (88 vs. 92%, NS [not significant]), but ETT was more specific than RNA (46 vs. 34%, P < 0.01). The prevalence of extensive CAD in patients with a positive treadmill (41%) increased only 3% when the RNA was also positive. However, in the 292 patients with a negative or indeterminate ETT, a positive RNA increased this prevalence from 16-23%, while a negative RNA decreased this prevalence to 5%. These results support the initial use of ETT followed by RNA if the treadmill is negative or indeterminate for diagnosis in a population with a high prevalence of extensive CAD. This approach separates patients into subgroups with a high or low probability of extensive CAD.