Prognostic implications of a negative dipyridamole-thallium scan: results in 360 patients.
METHODS
A total of 360 patients with either normal perfusion (314) or fixed defects (46) on dipyridamole-thallium scans were followed over an average period of 16 months. Of the 360 patients, 194 subsequently underwent major noncardiac surgery.


RESULTS
There were a total of eight cardiac events including two postoperative complications (one fatal and one nonfatal myocardial infarction) and six cardiac events during long-term follow-up (one sudden death and five nonfatal infarctions). During the follow-up period, three patients underwent coronary artery bypass surgery. The low cardiac event rate could not be explained by a low pretest likelihood of coronary artery disease: 77% of the 360 patients had either typical angina pectoris, a previous myocardial infarction, or peripheral vascular disease, which is associated with a high prevalence of coronary artery disease.


CONCLUSIONS
In patients with a high pretest likelihood of coronary artery disease, the absence of thallium redistribution on a dipyridamole-thallium scan denotes a very low (1%) cardiac risk for major noncardiac surgery as well as low long-term cardiac mortality (0.3%) and morbidity (1.4%) rates. The coronary death rate is comparable to that of patients with minimal (less than 50%) coronary stenoses.
Lette
J
J
Department of Medicine, Maisonneuve Hospital, Montreal, Quebec, Canada.
Waters
D
D
Champagne
P
P
Picard
M
M
Cerino
M
M
Lapointe
J
J
D002985:Clinical Protocols / Q000592:standards; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D004176:Dipyridamole; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology; D011877:Radionuclide Imaging / Q000009:adverse effects / Q000592:standards*; D013794:Thallium Radioisotopes
D013794:Thallium Radioisotopes; D004176:Dipyridamole