Dipyridamole-thallium-201 scintigraphy in the diagnosis and prognosis of coronary artery disease in patients undergoing noncardiac surgery.
Although most of the published studies using DTS as a preoperative screening test show various shortcomings, the following conclusions can be drawn: 1. DTS should not be used as a routine preoperative test in vascular surgical patients. DTS possesses insufficient accuracy when used in patients without clinical findings suggestive of CAD. 2. DTS may prove more useful in stratifying patients with an intermediate probability of developing cardiac complications. In such a population the test will not offer an "all or nothing" linear results, but rather, when included with the clinical findings and the nature of the surgical procedure, a complex stratification. 3. Because of progress in the perioperative management of high-risk patients, positive findings on preoperative DTS may not correlate perfectly with perioperative cardiac occurrences. 4. Because several factors influence thallium uptake after dipyridamole, DTS does not have perfect specificity, which leads to the prescribing of an excessive number of coronary angiographies. Some patients will be seen as having a false-positive DTS test. 5. The use of DTS as a preoperative screening test leads to cardiac catheterization and hence to revascularization independent of symptomatology. Studies must be undertaken to determine whether this approach will improve short- and long-term patient survival.
Coriat
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Baron
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Kieffer
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D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging*; D004176:Dipyridamole; D006801:Humans; D011379:Prognosis; D011877:Radionuclide Imaging; D013514:Surgical Procedures, Operative; D013794:Thallium Radioisotopes
D013794:Thallium Radioisotopes; D004176:Dipyridamole