Adenosine radionuclide perfusion imaging in the preoperative evaluation of patients undergoing peripheral vascular surgery.
To define the clinical and adenosine test variables that predicted perioperative cardiac events, 122 patients who received adenosine radionuclide perfusion imaging before peripheral vascular surgery were reviewed. Events included pulmonary edema, an ischemic end point of acute myocardial infarction (AMI) or cardiac death. Five patients underwent coronary revascularization before the surgical procedure. Of the 117 remaining patients, 19 had pulmonary edema, 10 had an AMI, and 2 died after peripheral vascular surgery. Most of the patients (78%) were in an intermediate-risk group as indicated by the presence of > or = 1 clinical risk factor as defined by the Eagle criteria. The only predictor of perioperative pulmonary edema was a history of congestive heart failure (33% vs 4%; p = 0.002). No clinical variables predicted AMI or death. The adenosine variables that were univariate predictors of AMI and death were the number of reversible perfusion defects (1.75 +/- 1.84 vs 0.75 +/- 0.90; p = 0.001) and the number of coronary artery distributions with a radionuclide perfusion defect (1.33 +/- 0.64 vs 0.85 +/- 0.67; p = 0.022). The number of reversible perfusion defects was the only multivariate predictor of ischemic events (p = 0.017). The presence of > 1 reversible defect was associated with an increased frequency of ischemic events (68% vs 28%; p = 0.045). The sensitivity and specificity of > 1 reversible defect was 58% and 73%, respectively, with a positive and negative predictive value of 19% and 94%.(ABSTRACT TRUNCATED AT 250 WORDS)
Marshall
E S
ES
Division of Cardiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Raichlen
J S
JS
Forman
S
S
Heyrich
G P
GP
Keen
W D
WD
Weitz
H H
HH
D000241:Adenosine; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology; D011877:Radionuclide Imaging; D012044:Regression Analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D000241:Adenosine