title: Does routine stress-thallium cardiac scanning reduce postoperative cardiac complications?
abstract: OBJECTIVE
  Prophylactic cardiac revascularization in patients with ischemic myocardium could reduce postoperative cardiac complications after aortic reconstruction. However, the effectiveness of this approach has not been documented.
  
  
  BACKGROUND
  Stress-thallium scanning can identify patients with ischemic myocardium. Morbidity and mortality after aortic reconstruction appears to be largely caused by co-existent coronary artery disease, and patients who have had recent cardiac revascularization have few postoperative cardiac complications.
  
  
  METHODS
  Preoperative stress-thallium scanning was evaluated prospectively in 146 patients undergoing aortic reconstruction. Patients with positive studies underwent coronary arteriography and cardiac revascularization, when appropriate. Postoperative cardiac complications and long-term survival in these patients were compared with results from 172 similar patients undergoing aortic reconstruction without stress-thallium scanning. Results also were analyzed to determine predictors of postoperative cardiac events.
  
  
  RESULTS
  Forty-one per cent of patients undergoing stress-thallium testing underwent coronary arteriography, and 11.6% had cardiac revascularization. In contrast, 14.7% of patients treated without stress-thallium testing had coronary arteriography, and 4.1% had revascularization (p < 0.01). Despite this, cardiac mortality, serious cardiac complications, and long-term cardiac mortality were similar in both groups. Only advanced age and intraoperative complications (but not a positive stress-thallium test) predicted postoperative cardiac events.
  
  
  CONCLUSIONS
  Preoperative stress-thallium testing confirmed a high incidence of significant coronary artery disease in patients undergoing aortic reconstruction, but prophylactic cardiac intervention does not reduce operative or long-term mortality. Thus, the risk and expense of routine stress-thallium testing and subsequent cardiac revascularization cannot be justified.
authors.affiliation: Department of Surgery, University of Florida, Gainesville.
authors.forename: J M
authors.initials: JM
authors.lastname: Seeger
authors.forename: G R
authors.initials: GR
authors.lastname: Rosenthal
authors.forename: S B
authors.initials: SB
authors.lastname: Self
authors.forename: T C
authors.initials: TC
authors.lastname: Flynn
authors.forename: M C
authors.initials: MC
authors.lastname: Limacher
authors.forename: T R
authors.initials: TR
authors.lastname: Harward
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000150:complications / Q000601:surgery*; D017023:Coronary Angiography; D005080:Exercise Test / Q000379:methods*; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013794:Thallium Radioisotopes
chemical_list: D013794:Thallium Radioisotopes