title: Routine perioperative dipyridamole 201Tl imaging in diabetic patients undergoing vascular surgery.
abstract: OBJECTIVE
  To assess the utility of dipyridamole thallium testing in symptomatic and asymptomatic patients with diabetes undergoing vascular surgery.
  
  
  METHODS
  Dipyridamole 201Tl myocardial scintigraphy was performed preoperatively in 93 consecutive patients with diabetes undergoing peripheral vascular procedures. The utility of clinical and thallium variables in predicting cardiovascular complications was assessed.
  
  
  RESULTS
  Two groups of patients were identified: group A (36 patients) without clinical evidence of cardiac disease and group B (57 patients) with clinical evidence of cardiac disease. Dipyridamole thallium scans were abnormal in 21 of 36 (58%) of group A patients compared with 53 of 57 (93%) of group B patients (P < 0.0001). Compared with group B patients with perfusion defects, group A patients with perfusion abnormalities tended to have fewer defects per scan (2.7 +/- 1.5 vs. 3.6 +/- 1.9, P = 0.05). No perioperative cardiac complications occurred in group A patients while perioperative cardiac complications occurred in 9 of 57 (16%, 95% CI 7-28%) group B patients (P = 0.01). For the entire study population, the complication rate was 10%.
  
  
  CONCLUSIONS
  Diabetic individuals without clinical markers for coronary artery disease appear to be at low risk for adverse postoperative cardiac events after vascular surgery. Preoperative myocardial perfusion imaging may add little to cardiovascular risk assessment in this subgroup of patients with diabetes.
authors.affiliation: Department of Medicine, Deaconess Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Zarich
authors.forename: M C
authors.initials: MC
authors.lastname: Cohen
authors.forename: S E
authors.initials: SE
authors.lastname: Lane
authors.forename: M A
authors.initials: MA
authors.lastname: Mittleman
authors.forename: R W
authors.initials: RW
authors.lastname: Nesto
authors.forename: T
authors.initials: T
authors.lastname: Hill
authors.forename: D
authors.initials: D
authors.lastname: Campbell
authors.forename: S M
authors.initials: SM
authors.lastname: Lewis
mesh_terms: D000368:Aged; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000601:surgery*; D004176:Dipyridamole / Q000627:therapeutic use*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D018579:Patient Selection; D011183:Postoperative Complications; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013794:Thallium Radioisotopes; D014656:Vascular Surgical Procedures / Q000009:adverse effects
chemical_list: D013794:Thallium Radioisotopes; D004176:Dipyridamole