Determination of perioperative cardiac risk by adenosine thallium-201 myocardial imaging

Leslee Shaw, Donald D Miller, Barbara A. Kong, Thomas Hilton, Art Stelken, Karen Stocke, Bernard R. Chaitman

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Abstract

To determine the predictive value of adenosine thallium-201 myocardial imaging for perioperative cardiac events, 60 consecutive patients referred for preoperative cardiac evaluation were studied before vascular (n = 25), orthopedic (n = 14), or general (n = 21) surgery. Tomographic (n = 52) and planar (n = 8) thallium-201 imaging was performed after adenosine infusion at a rate of 140 μg/kg/min for 6 minutes. Two blinded expert observers graded results of adenosine thallium-201 studies as normal (33%), fixed defect only (2%), reversible defect only (48%), and combined (fixed and reversible) defects (17%). After 8 ± 3 months of follow-up, 81% proceeded to surgery and 43% underwent preoperative coronary angiography. Clinical variables that correlated with perioperative cardiac events were a history of diabetes mellitus (p = 0.05), left bundle branch block (p = 0.02), and left ventricular hypertrophy (p = 0.06) on the resting ECG. This clinically "high-risk" group had an event rate of 22% as compared with no cardiac events in patients in the "low-risk" group without these clinical characteristics (p = 0.005). Stepwise logistic regression analysis revealed that the presence of a combined (fixed and reversible) adenosine thallium-201 defect (p = 0.0007), three-vessel coronary artery disease (p = 0.001), and left bundle branch block (p = 0.02) was predictive of subsequent cardiac events with relative risk ratios of 4.9, 2.9, and 2.2, respectively. Therefore the presence of an adenosine thallium-201 perfusion defect is correlated with and predictive of an increased risk of perioperative cardiac events in patients referred for preoperative risk evaluation.

Original languageEnglish (US)
Pages (from-to)861-869
Number of pages9
JournalAmerican Heart Journal
Volume124
Issue number4
DOIs
StatePublished - Jan 1 1992

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Thallium
Adenosine
Bundle-Branch Block
Left Ventricular Hypertrophy
Coronary Angiography
Orthopedics
Blood Vessels
Coronary Artery Disease
Diabetes Mellitus
Electrocardiography
Perfusion
Logistic Models
Odds Ratio
Regression Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Determination of perioperative cardiac risk by adenosine thallium-201 myocardial imaging. / Shaw, Leslee; Miller, Donald D; Kong, Barbara A.; Hilton, Thomas; Stelken, Art; Stocke, Karen; Chaitman, Bernard R.

In: American Heart Journal, Vol. 124, No. 4, 01.01.1992, p. 861-869.

Research output: Contribution to journalArticle

Shaw, Leslee ; Miller, Donald D ; Kong, Barbara A. ; Hilton, Thomas ; Stelken, Art ; Stocke, Karen ; Chaitman, Bernard R. / Determination of perioperative cardiac risk by adenosine thallium-201 myocardial imaging. In: American Heart Journal. 1992 ; Vol. 124, No. 4. pp. 861-869.
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