title: Dipyridamole technetium 99m sestamibi myocardial tomography for preoperative cardiac risk stratification before major or minor nonvascular surgery.
abstract: The value of dipyridamole technetium 99m sestamibi (MIBI) tomography for preoperative cardiac risk stratification was assessed in 285 consecutive patients being considered for nonvascular surgery. A "major" (n = 140) or "minor" (n = 89) nonvascular procedure was later done in 229 of these patients < or = 4 months after dipyridamole testing. Perioperative cardiac events (unstable angina, acute ischemic pulmonary edema, nonfatal myocardial infarction, or cardiac death) occurred in 11 (8%) patients undergoing major nonvascular surgery and 1 (1%) undergoing a minor procedure. The only clinical or scintigraphic variables associated with significantly increased perioperative cardiac risk in patients having major surgery were Goldman class > or = II, an abnormal MIBI scan, and a fixed perfusion defect. In these patients, cardiac events occurred in 1% of those who had a normal MIBI study, 14% of those with an abnormal scan (p < 0.01), 12% with a reversible MIBI defect (p = 0.29), and 17% with a fixed MIBI defect (p < 0.01). In the 60 patients whose Goldman class was > or = II, only an abnormal MIBI study and a fixed perfusion defect were associated with incremental risk of a perioperative cardiac event. The incidence of perioperative cardiac events in these patients was 4% with a normal MIBI scan, 27% with an abnormal study (p < 0.05), 24% with a reversible MIBI defect (p = 0.45), and 37% with a fixed defect (p < 0.01). Event rates were low in patients having minor nonvascular surgery; none of the 25 with a normal MIBI study and only 1 of the 64 with an abnormal scan had a perioperative cardiac event (p = not significant (NS). We conclude that dipyridamole MIBI tomography can provide important prognostic information in patients having major nonvascular surgery. A normal MIBI study indicates a low risk of perioperative cardiac events, whereas an abnormal study in patients with Goldman class > or = II undergoing major surgery is associated with significantly increased risk. The prognostic value of MIBI tomography in patients at low clinical risk undergoing minor surgery is limited.
authors.affiliation: Department of Internal Medicine, St. Louis Veterans Administration Medical Center, MO 63106, USA.
authors.forename: H G
authors.initials: HG
authors.lastname: Stratmann
authors.forename: L T
authors.initials: LT
authors.lastname: Younis
authors.forename: M D
authors.initials: MD
authors.lastname: Wittry
authors.forename: M
authors.initials: M
authors.lastname: Amato
authors.forename: A L
authors.initials: AL
authors.lastname: Mark
authors.forename: D D
authors.initials: DD
authors.lastname: Miller
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000209:etiology; D003326:Coronary Circulation; D003327:Coronary Disease / Q000145:classification / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004176:Dipyridamole; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D013511:Minor Surgical Procedures; D009203:Myocardial Infarction / Q000209:etiology; D011183:Postoperative Complications; D011300:Preoperative Care; D011379:Prognosis; D011654:Pulmonary Edema / Q000209:etiology; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi