(Chest. 2004;126:1040-1041.)
© 2004
American College of Chest Physicians
Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value of the Dipyridamole Sestamibi Stress Test Comparing Arterial to Vein Conduits*
Albert J. DeLuca, MD;
Evelyn Cusack, MD;
Wilbert S. Aronow, MD, FCCP and
Craig E. Monsen, MD
* From the Department of Medicine, Cardiology Division, Westchester Medical Center/New York Medical College, Valhalla, NY.
Correspondence to: Wilbert S. Aronow, MD, Cardiology Division, New York Medical College, Macy Pavilion, Room 138, Valhalla, NY 10595; e-mail: WSAronow{at}aol.com
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Abstract
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Study objectives: To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the dipyridamole stress test (DSST) in predicting 
50% obstruction of an internal mammary artery or new native coronary artery disease (CAD) compared with saphenous vein graft obstruction 50% in patients with prior coronary artery surgery and symptoms.
Design: In 144 patients with prior coronary artery surgery who underwent a DSST within 8 ± 7 days of coronary angiography performed because of cardiac symptoms, we investigated the sensitivity, specificity, PPV, and NPV of the DSST in predicting 50% obstruction of an internal mammary artery or new native CAD (201 total arterial conduits) vs 50% obstruction of saphenous vein grafts (total saphenous grafts = 246).
Setting: A university hospital.
Patients: The 144 patients included 88 men and 56 women, mean age 68 ± 9 years (± SD).
Results: The DSST had a sensitivity of 81%, a specificity of 87%, a PPV of 84%, and a NPV of 84% in predicting 50% obstruction of an internal mammary artery or new native CAD. The DSST had a sensitivity of 88%, a specificity of 82%, a PPV of 86%, and a NPV of 85% in predicting 50% obstruction of saphenous vein grafts.
Conclusion: There was no significant difference in sensitivity, specificity, PPV, or NPV of the DSST in predicting 50% obstruction of an internal mammary artery or new native CAD vs predicting 50% obstruction of saphenous vein grafts in patients with prior coronary artery surgery and cardiac symptoms.
Key Words: coronary artery disease • coronary artery surgery • dipyridamole sestamibi stress test • internal mammary artery • saphenous vein grafts
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Introduction
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The dipyridamole sestamibi stress test (DSST) is useful in detecting myocardial ischemia due to obstructive coronary artery disease (CAD).123 However, to the best of our knowledge, there are no published data showing in patients with prior coronary artery surgery the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the DSST in diagnosing 50% obstruction of an internal mammary artery or new native CAD (defined as 50% obstruction in either a previously unbypassed coronary artery or distal to the insertion of a bypass graft) or in predicting saphenous vein graft obstruction 50%. This article reports the sensitivity, specificity, PPV, and NPV of the DSST in diagnosing 50% obstruction of an internal mammary artery or new native CAD vs saphenous vein graft obstruction 50% in 144 patients with prior coronary artery surgery who underwent coronary angiography because of cardiac symptoms. Therefore, the uniqueness of this article is the comparison of arterial to vein conduits.
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Materials and Methods
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The 144 patients included 88 men and 56 women, mean age 68 ± 9 years (± SD; range, 43 to 85 years), with prior coronary artery surgery who underwent a DSST within 8 ± 7 days of coronary angiography performed because of cardiac symptoms. One hundred four of the 144 patients (72%) were white. The DSST was performed as previously described.45
We investigated the sensitivity, specificity, PPV, and NPV of the DSST in predicting 50% obstruction of an internal mammary artery (n = 121) or new native CAD (n = 80; 201 total arterial conduits) vs 50% obstruction of saphenous vein grafts (total saphenous vein grafts = 246). New native CAD was defined as 50% obstruction in either a previously unbypassed coronary artery or distal to the insertion site of a bypass graft. The three patients with both disease of the saphenous vein bypass graft and new native vessel disease were classified as having new native vessel disease. The quantification of lesions in the arteries or venous grafts was made visually. Student t tests were used to analyze continuous variables. 
2 tests were used to analyze dichotomous variables.
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Results
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Table 1
shows the sensitivity, specificity, PPV, and NPV of the DSST in predicting 50% obstruction of an internal mammary artery or new native CAD vs saphenous vein obstruction 50%. Table 1 also lists levels of statistical significance. There was no significant difference in sensitivity, specificity, PPV, or NPV if obstruction of arterial conduits was compared with distal arterial disease or venous graft disease.
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Table 1.. Sensitivity, Specificity, PPV, and NPV of the DSST in Predicting Internal Mammary Artery Obstruction or New Native CAD vs Saphenous Vein Graft Obstruction in Patients With Prior Coronary Artery Surgery*
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Discussion
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The DSST is useful in detecting myocardial ischemia due to obstructive CAD.123 However, to the best of our knowledge, there are no published data showing the sensitivity, specificity, PPV, and NPV of the DSST in predicting either 50% obstruction of an internal mammary artery or new native CAD (defined as 50% obstruction in either a previously unbypassed coronary artery or distal to the insertion site of a bypass graft) or in predicting saphenous vein graft obstruction 50% in patients with prior coronary artery surgery and symptoms. The present study showed in 144 patients that the sensitivity, specificity, PPV, and NPV, respectively, of the DSST in predicting internal mammary artery obstruction or new native CAD vs saphenous vein graft obstruction were 81% vs 88%, 87% vs 82%, 84% vs 86%, and 84% vs 85%. Despite the physiologic differences in vasodilator properties of dipyridamole in arterial vs venous conduits, there was no significant difference in sensitivity, specificity, PPV, or NPV of the DSST in predicting 50% obstruction of an internal mammary artery or new native CAD vs 50% obstruction of saphenous vein grafts in patients with prior coronary artery surgery and cardiac symptoms. There was no significant difference in sensitivity, specificity, PPV, or NPV if obstruction of arterial conduits was compared with distal arterial disease or venous graft disease.
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Footnotes
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Abbreviations: CAD = coronary artery disease; DSST = dipyridamole sestamibi stress test; NPV = negative predictive value; PPV = positive predictive value
Received for publication February 4, 2004.
Accepted for publication May 7, 2004.
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References
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- Candell-Riera, J, Santana-Boado, C, Castell-Conesa, J, et al (2000) Dipyridamole administration at the end of an insufficient exercise Tc-99m MIBI SPECT improves detection of multivessel coronary artery disease in patients with previous myocardial infarction. Am J Cardiol 85,532-535[CrossRef][ISI][Medline]
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- Soman, P, Taillefer, R, DePuey, EG, et al Enhanced detection of reversible perfusion defects by Tc-99m sestamibi compared to Tc-99m tetrofosmin during vasodilator stress SPECT imaging in mild-to-moderate coronary artery disease. J Am Coll Cardiol 2001;37,458-462[Abstract/Free Full Text]
- Belkin, RN, Ghosh, J, DeLuca, AJ, et al Comparison of two-dimensional echocardiographic tissue harmonic imaging and gated sestamibi singe-photon emission computed tomographic left ventricular ejection fraction measurements. Am J Cardiol 2003;92,759-762[CrossRef][ISI][Medline]
- Taillefer, R Ahlberg AW, Masood Y, et al. Acute ß-blockade reduces the extent and severity of myocardial perfusion defects with dipyridamole Tc-99m sestamibi SPECT imaging. J Am Coll Cardiol 2003;42,1475-1483[Abstract/Free Full Text]
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Abstract
Introduction
