Preoperative risk stratification with myocardial perfusion imaging in intermediate and low-risk non-cardiac surgery.
BACKGROUND
Perioperative cardiac risk in high risk surgery is often stratified with myocardial perfusion single-photon emission computed tomography (SPECT). However, little and no data are available about intermediate and low-risk surgery, respectively.


RESULTS
A total of 1,220 consecutive patients underwent electrocardiography-gated dipyridamole stress SPECT to evaluate myocardial perfusion and cardiac function before intermediate or low risk non-cardiac surgery. Variables predictive of perioperative cardiac events were determined and the usefulness of combining pretest information and the incremental prognostic value of SPECT was estimated. The frequency of all cardiac events depended on clinical risk factors and type of surgical procedures. After sorting the patients with clinical risk factors and surgical risk, assessment of myocardial perfusion or cardiac function yielded significant risk stratification in intermediate, but not in low-risk surgery. Adding functional data to perfusion variables offered an incremental prognostic value for patients with an intermediate clinical risk and scheduled intermediate risk surgery.


CONCLUSIONS
Integrating information about clinical risk factors, type of surgery, myocardial perfusion and cardiac function allows detailed preoperative risk stratification. Preoperative SPECT provides an incremental prognostic value in intermediate, but not in low-risk surgery.
Hashimoto
Jun
J
Department of Radiology, School of Medicine, Keio University, Tokyo, Japan. junhashi@rad.med.keio.ac.jp
Nakahara
Tadaki
T
Bai
Jingming
J
Kitamura
Naoto
N
Kasamatsu
Tomotaka
T
Kubo
Atsushi
A
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon