title: Dipyridamole-thallium/sestamibi before vascular surgery: a prospective blinded study in moderate-risk patients.
abstract: OBJECTIVE
  This study assessed in a prospective, blinded fashion whether a reversible defect on dipyridamole-thallium (DTHAL)/sestamibi (DMIBI) can predict adverse cardiac events after elective vascular surgery in patients with one or more clinical risk factors.
  
  
  METHODS
  Consecutive patients with one or more clinical risk factors underwent a preoperative blinded DTHAL/DMIBI. Patients with recent congestive heart failure (CHF) or myocardial infarction (MI) or severe or unstable angina were excluded.
  
  
  RESULTS
  Eighty patients (78% men; mean age, 65 years) completed the study. Diabetes mellitus was the most frequent clinical risk factor (73%), followed by age older than 70 years (41%), angina (29%), Q wave on electrocardiogram (26%), history of CHF (7%), and ventricular ectopy (3%). The results of DTHAL/DMIBI were normal in 36 patients (45%); a reversible plus or minus fixed defect was demonstrated in 28 patients (36%), and a fixed defect alone was demonstrated in 15 patients (19%). Nine adverse cardiac events (11%) occurred, including three cases of CHF, and one case each of unstable angina, Q wave MI, non-Q wave MI, and cardiac arrest (successfully resuscitated). Two cardiac deaths occurred (2% overall mortality), one after a Q wave MI and one after CHF and a non-Q wave MI. The cardiac event rate was 14% for reversible defect and 9.8% without reversible defect (P =.71). The cardiac event rate was 12.5% (one of eight cases) for two or more reversible defects, versus 11.1% (eight of 72 cases) for fewer than two reversible defects (P = 1.0). The sensitivity rate of two or more areas of redistribution was 11% (95% CI, 0.3%-48%), the specificity rate was 90%, and the positive and negative predictive values were 12.5% and 89%, respectively.
  
  
  CONCLUSIONS
  Our study demonstrated no association between reversible defects on DTHAL/DMIBI and adverse cardiac events in moderate-risk patients undergoing elective vascular surgery.
authors.affiliation: Departments of Surgery, Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
authors.forename: C
authors.initials: C
authors.lastname: de Virgilio
authors.forename: K
authors.initials: K
authors.lastname: Toosie
authors.forename: M
authors.initials: M
authors.lastname: Elbassir
authors.forename: C
authors.initials: C
authors.lastname: Donayre
authors.forename: J D
authors.initials: JD
authors.lastname: Baker
authors.forename: K
authors.initials: K
authors.lastname: Narahara
authors.forename: F
authors.initials: F
authors.lastname: Mishkin
authors.forename: R J
authors.initials: RJ
authors.lastname: Lewis
authors.forename: C
authors.initials: C
authors.lastname: Chang
authors.forename: R
authors.initials: R
authors.lastname: White
authors.forename: F V
authors.initials: FV
authors.lastname: Mody
mesh_terms: D000368:Aged; D004176:Dipyridamole; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D014656:Vascular Surgical Procedures; D014665:Vasodilator Agents
chemical_list: D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D014665:Vasodilator Agents; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi