Value of pharmacologic stress myocardial perfusion imaging for preoperative risk stratification for aortic surgery.
BACKGROUND
Aortic surgery is an invasive, high-risk noncardiac procedure and the patients who require it have a high prevalence of coronary artery disease. Therefore, preoperative risk stratification for this subset is essential.


RESULTS
To assess the perioperative risk for aortic surgery, pharmacologic stress single-photon emission computed tomography (SPECT) was performed in 302 patients: aortic dissection in 56, thoracic aortic aneurysm in 124, and abdominal aortic aneurysm in 122. Not only was the presence or absence of perfusion defects analyzed, but also the 20-segment model. Pharmacologic thallium SPECT revealed negative findings in 210 patients and positives in 92. Perioperative cardiac events occurred in 9 patients: 7 occurred in patients with positive SPECT, and in only 2 of those with negative SPECT (2/210 vs 7/92; p<0.05). Multivariate analysis using logistic regression model revealed that a summed stress score>or=14 was the most important factor to identify patients who subsequently had perioperative cardiac events.


CONCLUSIONS
Pharmacologic stress SPECT has significant value in the risk stratification of patients before aortic surgery. In patients with positive SPECT, an aggressive approach to reduce the preoperative risk is necessary, whereas aortic surgery can be performed safely in patients with negative SPECT.
Harafuji
Katsufumi
K
Department of Internal Medicine II, Tokyo Medical University, Japan. fwnf8022@mb.infoweb.ne.jp
Chikamori
Taishiro
T
Kawaguchi
Satoshi
S
Obitsu
Yukio
Y
Ito
Shigeki
S
Igarashi
Yuko
Y
Tanaka
Hirokazu
H
Usui
Yasuhiro
Y
Hida
Satoshi
S
Ishimaru
Shin
S
Yamashina
Akira
A
D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000601:surgery; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D018570:Risk Assessment; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon