title: Dipyridamole-thallium scintigraphy and gated radionuclide angiography to assess cardiac risk before abdominal aortic surgery.
abstract: BACKGROUND
  Because many patients with atherosclerotic disease of the abdominal aorta also have coronary artery disease, assessment of cardiac risk before abdominal aortic surgery has received much attention. Our prospective study was designed to identify predictors of cardiac risk in consecutive patients evaluated preoperatively with dipyridamole-thallium single-photon-emission computed tomography (SPECT) to assess myocardial perfusion and radionuclide angiography to measure left ventricular ejection fraction.
  
  
  METHODS
  Clinical and scintigraphic data were collected prospectively during hospitalization in 457 consecutive patients undergoing elective abdominal aortic surgery. Adverse cardiac outcomes were predicted with multivariate analyses.
  
  
  RESULTS
  Eighty-six patients (19 percent) had one or more of the following postoperative complications: prolonged myocardial ischemia (61 patients), myocardial infarction (22), congestive heart failure (20), and severe ventricular tachyarrhythmia (2). Twenty patients died postoperatively (4.4 percent), half of them from cardiac causes. Information about myocardial perfusion obtained from dipyridamole-thallium SPECT did not accurately predict adverse cardiac outcomes. The best correlates of cardiac complications were definite clinical evidence of coronary artery disease (odds ratio, 2.6; 95 percent confidence interval, 1.6 to 4.3) and age greater than 65 years (odds ratio, 2.3; 95 percent confidence interval, 1.4 to 3.6). Measurement of the ejection fraction was useful only in the prediction of left ventricular failure. Age greater than 65 years was the only predictor of death (odds ratio, 26.4; 95 percent confidence interval, 3.5 to 200.0).
  
  
  CONCLUSIONS
  The presence of definite clinical evidence of coronary artery disease and older age were the most important preoperative predictors of an adverse cardiac outcome after abdominal aortic surgery. These results suggest that the routine use of dipyridamole-thallium SPECT and radionuclide angiography for screening before abdominal aortic surgery may not be justified.
authors.affiliation: Department of Anesthesiology, Hôpital Pitié-Salpétrière, Paris, France.
authors.forename: J F
authors.initials: JF
authors.lastname: Baron
authors.forename: O
authors.initials: O
authors.lastname: Mundler
authors.forename: M
authors.initials: M
authors.lastname: Bertrand
authors.forename: E
authors.initials: E
authors.lastname: Vicaut
authors.forename: E
authors.initials: E
authors.lastname: Barré
authors.forename: G
authors.initials: G
authors.lastname: Godet
authors.forename: C M
authors.initials: CM
authors.lastname: Samama
authors.forename: P
authors.initials: P
authors.lastname: Coriat
authors.forename: E
authors.initials: E
authors.lastname: Kieffer
authors.forename: P
authors.initials: P
authors.lastname: Viars
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery; D003326:Coronary Circulation; D004176:Dipyridamole; D017558:Elective Surgical Procedures; D015637:Gated Blood-Pool Imaging; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D013318:Stroke Volume; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013794:Thallium Radioisotopes; D004176:Dipyridamole