Preoperative and long-term cardiac risk assessment. Predictive value of 23 clinical descriptors, 7 multivariate scoring systems, and quantitative dipyridamole imaging in 360 patients.
A total of 360 patients underwent preoperative cardiac risk assessment using 23 clinical parameters, seven multivariate clinical scoring systems, and quantitative dipyridamole-thallium imaging to predict postoperative and long-term myocardial infarction and cardiac death after noncardiac surgery. There were 30 postoperative and an additional 13 cumulative long-term cardiac events after an average follow-up of 15 months. Clinical descriptors were not useful in predicting the outcome of individual patients. The postoperative and long-term cardiac event rates were 1% and 3.5%, respectively, in patients with normal scans or fixed perfusion defects, and 17.5% and 22% in patients with reversible defects. Using quantitative indices reflecting the amount of jeopardized myocardium, patients could be stratified by dipyridamole imaging into multiple scintigraphic subsets, with corresponding postoperative and 1-year coronary morbidity and mortality rates ranging from 0.5% to 100% (p = 0.0001). Thus, postoperative and long-term cardiac events cannot be predicted clinically, whereas quantitative dipyridamole imaging accurately identifies high-risk patients who require preoperative coronary angiography.
Lette
J
J
Department of Medicine, Maisonneuve Hospital, Montreal, Quebec, Canada.
Waters
D
D
Bernier
H
H
Champagne
P
P
Lassonde
J
J
Picard
M
M
Cerino
M
M
Nattel
S
S
Boucher
Y
Y
Heyen
F
F
D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology*; D004176:Dipyridamole; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D013794:Thallium Radioisotopes; D013997:Time Factors
D013794:Thallium Radioisotopes; D004176:Dipyridamole