TY - JOUR
T1 - Preoperative clinical assessment and dipyridamole thallium-201 scintigraphy for prediction and prevention of cardiac events in patients having major noncardiovascular surgery and known or suspected coronary artery disease
AU - Younis, Liwa
AU - Stratmann, Henry
AU - Takase, Bonpei
AU - Byers, Sheila
AU - Chaitman, Bernard R.
AU - Miller, D. Douglas
N1 - Funding Information:
From the Division of Cardiology, Department of Internal Medicine. Saint Louis University Health Sciences Center & Veteran’s Administration Medical Center, St. Louis, Missouri. This study was supported in pm by the Lichtenstein Foundation, St. Louis, Missouri. Manuscript received December 6, 1993; revised manuscript received February Il. 1994, and accepted February 14. Address for reprints: D. Douglas Miller, MD, Saint Louis University Medical Center, Division of Cardiology, 14th floor, 3635 Vista Avenue at Grand Boulevard, P.O. Box 152S0, St. Louis, Missouri 63 I 1O - 0250.
PY - 1994/8/15
Y1 - 1994/8/15
N2 - The aim of this study was to assess the relative prognostic use of clinical risk stratification and intravenous dipyridamole thallium-201 scintigraphy in patients with an intermediate to high prevalence of coronary artery disease (CAD) who have undergone major noncardiovascular surgery, and to assess the effects of medical therapy or coronary revascularization based on the result of this clinical scintigraphic screening on perioperative cardiac morbidity and mortality. Patients (n = 161) with an intermediate to high likelihood of CAD had clinical assessment and intravenous dipyridamole planar thallium-201 testing which was analyzed semiquantitatively. Cardiac events were cardiac death (n = 9), nonfatal myocardial infarction (n = 6), acute pulmonary edema (n = 6), and unstable angina (n = 4). Multiple (≥2) clinical risk variables predicted any cardiac event (p = 0.04). Presence of multiple (≥2) abnormal thallium-201 segments was the only independent predictor of cardiac death or nonfatal myocardial infarction (p < 0.001), and was the most powerful multivariate predictor of any cardiac event (p < 0.002). Patients with an abnormal dipyridamole thallium-201 scan had a higher risk of perioperative cardiac death, myocardial infarction (18% vs 2%; p < 0.001), or any perioperative cardiac event (27% vs 6%; p < 0.001) when compared with those with a normal scan. Preoperative changes in anti-ischemic therapy or coronary revascularization in 36 of 72 patients with abnormal dipyridamole thallium-201 studies reduced perioperative death or myocardial infarction from 31% to 6% (p < 0.01), and all cardiac events from 47% to 8% (p < 0.001) compared with those in patients without intervention. Clinical and scintigraphic risk stratification can identify high-risk, major noncardiovascular surgery patients in whom perioperative outcome can benefit from appropriate preoperative therapeutic interventions.
AB - The aim of this study was to assess the relative prognostic use of clinical risk stratification and intravenous dipyridamole thallium-201 scintigraphy in patients with an intermediate to high prevalence of coronary artery disease (CAD) who have undergone major noncardiovascular surgery, and to assess the effects of medical therapy or coronary revascularization based on the result of this clinical scintigraphic screening on perioperative cardiac morbidity and mortality. Patients (n = 161) with an intermediate to high likelihood of CAD had clinical assessment and intravenous dipyridamole planar thallium-201 testing which was analyzed semiquantitatively. Cardiac events were cardiac death (n = 9), nonfatal myocardial infarction (n = 6), acute pulmonary edema (n = 6), and unstable angina (n = 4). Multiple (≥2) clinical risk variables predicted any cardiac event (p = 0.04). Presence of multiple (≥2) abnormal thallium-201 segments was the only independent predictor of cardiac death or nonfatal myocardial infarction (p < 0.001), and was the most powerful multivariate predictor of any cardiac event (p < 0.002). Patients with an abnormal dipyridamole thallium-201 scan had a higher risk of perioperative cardiac death, myocardial infarction (18% vs 2%; p < 0.001), or any perioperative cardiac event (27% vs 6%; p < 0.001) when compared with those with a normal scan. Preoperative changes in anti-ischemic therapy or coronary revascularization in 36 of 72 patients with abnormal dipyridamole thallium-201 studies reduced perioperative death or myocardial infarction from 31% to 6% (p < 0.01), and all cardiac events from 47% to 8% (p < 0.001) compared with those in patients without intervention. Clinical and scintigraphic risk stratification can identify high-risk, major noncardiovascular surgery patients in whom perioperative outcome can benefit from appropriate preoperative therapeutic interventions.
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U2 - 10.1016/0002-9149(94)90395-6
DO - 10.1016/0002-9149(94)90395-6
M3 - Article
C2 - 8059690
AN - SCOPUS:0027934754
SN - 0002-9149
VL - 74
SP - 311
EP - 317
JO - The American Journal of Cardiology
JF - The American Journal of Cardiology
IS - 4
ER -