TY - JOUR
T1 - Dipyridamole technetium 99m sestamibi myocardial tomography for preoperative cardiac risk stratification before major or minor nonvascular surgery
AU - Stratmann, Henry G.
AU - Younis, Liwa T.
AU - Wittry, Mark D.
AU - Amato, Maryellen
AU - Mark, Alexander L.
AU - Miller, D. Douglas
PY - 1996
Y1 - 1996
N2 - The value of dipyridamole technetium 99m sestamibi (MIBI) tomography for preoperative cardiac risk stratification was assessed in 285 consecutive patients being considered for nonvascular surgery. A 'major' (n = 140) or 'minor' (n = 89) nonvascular procedure was later done in 229 of these patients ≤4 months after dipyridamole testing. Perioperative cardiac events (unstable angina, acute ischemic pulmonary edema, nonfatal myocardial infarction, or cardiac death) occurred in 11 (8%) patients undergoing major nonvascular surgery and 1 (1%) undergoing a minor procedure. The only clinical or scintigraphic variables associated with significantly increased perioperative cardiac risk in patients having major surgery were Goldman class ≤II, an abnormal MIBI scan, and a fixed perfusion defect. In these patients, cardiac events occurred in 1% of those who had a normal MIBI study, 14% of those with an abnormal scan (p < 0.01), 12% with a reversible MIBI defect (p = 0.29), and 17% with a fixed MIBI defect (p < 0.01). In the 60 patients whose Goldman class was ≤II, only an abnormal MIBI study and a fixed perfusion defect were associated with incremental risk of a perioperative cardiac event. The incidence of perioperative cardiac events in these patients was 4% with a normal MIBI scan, 27% with an abnormal study (p < 0.05), 24% with a reversible MIBI defect (p = 0.45), and 37% with a fixed defect (p < 0.01). Event rates were low in patients having minor nonvascular surgery; none of the 25 with a normal MIBI study and only 1 of the 64 with an abnormal scan had a perioperative cardiac event (p = not significant (NS). We conclude that dipyridamole MIBI tomography can provide important prognostic information in patients having major nonvascular surgery. A normal MIBI study indicates a low risk of perioperative cardiac events, whereas an abnormal study in patients with Goldman class ≤II undergoing major surgery is associated with significantly increased risk. The prognostic value of MIBI tomography in patients at low clinical risk undergoing minor surgery is limited.
AB - The value of dipyridamole technetium 99m sestamibi (MIBI) tomography for preoperative cardiac risk stratification was assessed in 285 consecutive patients being considered for nonvascular surgery. A 'major' (n = 140) or 'minor' (n = 89) nonvascular procedure was later done in 229 of these patients ≤4 months after dipyridamole testing. Perioperative cardiac events (unstable angina, acute ischemic pulmonary edema, nonfatal myocardial infarction, or cardiac death) occurred in 11 (8%) patients undergoing major nonvascular surgery and 1 (1%) undergoing a minor procedure. The only clinical or scintigraphic variables associated with significantly increased perioperative cardiac risk in patients having major surgery were Goldman class ≤II, an abnormal MIBI scan, and a fixed perfusion defect. In these patients, cardiac events occurred in 1% of those who had a normal MIBI study, 14% of those with an abnormal scan (p < 0.01), 12% with a reversible MIBI defect (p = 0.29), and 17% with a fixed MIBI defect (p < 0.01). In the 60 patients whose Goldman class was ≤II, only an abnormal MIBI study and a fixed perfusion defect were associated with incremental risk of a perioperative cardiac event. The incidence of perioperative cardiac events in these patients was 4% with a normal MIBI scan, 27% with an abnormal study (p < 0.05), 24% with a reversible MIBI defect (p = 0.45), and 37% with a fixed defect (p < 0.01). Event rates were low in patients having minor nonvascular surgery; none of the 25 with a normal MIBI study and only 1 of the 64 with an abnormal scan had a perioperative cardiac event (p = not significant (NS). We conclude that dipyridamole MIBI tomography can provide important prognostic information in patients having major nonvascular surgery. A normal MIBI study indicates a low risk of perioperative cardiac events, whereas an abnormal study in patients with Goldman class ≤II undergoing major surgery is associated with significantly increased risk. The prognostic value of MIBI tomography in patients at low clinical risk undergoing minor surgery is limited.
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U2 - 10.1016/S0002-8703(96)90235-5
DO - 10.1016/S0002-8703(96)90235-5
M3 - Article
C2 - 8800022
AN - SCOPUS:0029970716
SN - 0002-8703
VL - 132
SP - 536
EP - 541
JO - American Heart Journal
JF - American Heart Journal
IS - 3
ER -