Preoperative clinical assessment and dipyridamole thallium-201 scintigraphy for prediction and prevention of cardiac events in patients having major noncardiovascular surgery and known or suspected coronary artery disease

Liwa Younis, Henry Stratmann, Bonpei Takase, Sheila Byers, Bernard R. Chaitman, Donald D Miller

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Abstract

The aim of this study was to assess the relative prognostic use of clinical risk stratification and intravenous dipyridamole thallium-201 scintigraphy in patients with an intermediate to high prevalence of coronary artery disease (CAD) who have undergone major noncardiovascular surgery, and to assess the effects of medical therapy or coronary revascularization based on the result of this clinical scintigraphic screening on perioperative cardiac morbidity and mortality. Patients (n = 161) with an intermediate to high likelihood of CAD had clinical assessment and intravenous dipyridamole planar thallium-201 testing which was analyzed semiquantitatively. Cardiac events were cardiac death (n = 9), nonfatal myocardial infarction (n = 6), acute pulmonary edema (n = 6), and unstable angina (n = 4). Multiple (≥2) clinical risk variables predicted any cardiac event (p = 0.04). Presence of multiple (≥2) abnormal thallium-201 segments was the only independent predictor of cardiac death or nonfatal myocardial infarction (p < 0.001), and was the most powerful multivariate predictor of any cardiac event (p < 0.002). Patients with an abnormal dipyridamole thallium-201 scan had a higher risk of perioperative cardiac death, myocardial infarction (18% vs 2%; p < 0.001), or any perioperative cardiac event (27% vs 6%; p < 0.001) when compared with those with a normal scan. Preoperative changes in anti-ischemic therapy or coronary revascularization in 36 of 72 patients with abnormal dipyridamole thallium-201 studies reduced perioperative death or myocardial infarction from 31% to 6% (p < 0.01), and all cardiac events from 47% to 8% (p < 0.001) compared with those in patients without intervention. Clinical and scintigraphic risk stratification can identify high-risk, major noncardiovascular surgery patients in whom perioperative outcome can benefit from appropriate preoperative therapeutic interventions.

Original languageEnglish (US)
Pages (from-to)311-317
Number of pages7
JournalThe American Journal of Cardiology
Volume74
Issue number4
DOIs
StatePublished - Aug 15 1994
Externally publishedYes

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Dipyridamole
Thallium
Radionuclide Imaging
Coronary Artery Disease
Myocardial Infarction
Unstable Angina
Pulmonary Edema
Therapeutics
Morbidity
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Preoperative clinical assessment and dipyridamole thallium-201 scintigraphy for prediction and prevention of cardiac events in patients having major noncardiovascular surgery and known or suspected coronary artery disease. / Younis, Liwa; Stratmann, Henry; Takase, Bonpei; Byers, Sheila; Chaitman, Bernard R.; Miller, Donald D.

In: The American Journal of Cardiology, Vol. 74, No. 4, 15.08.1994, p. 311-317.

Research output: Contribution to journalArticle

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abstract = "The aim of this study was to assess the relative prognostic use of clinical risk stratification and intravenous dipyridamole thallium-201 scintigraphy in patients with an intermediate to high prevalence of coronary artery disease (CAD) who have undergone major noncardiovascular surgery, and to assess the effects of medical therapy or coronary revascularization based on the result of this clinical scintigraphic screening on perioperative cardiac morbidity and mortality. Patients (n = 161) with an intermediate to high likelihood of CAD had clinical assessment and intravenous dipyridamole planar thallium-201 testing which was analyzed semiquantitatively. Cardiac events were cardiac death (n = 9), nonfatal myocardial infarction (n = 6), acute pulmonary edema (n = 6), and unstable angina (n = 4). Multiple (≥2) clinical risk variables predicted any cardiac event (p = 0.04). Presence of multiple (≥2) abnormal thallium-201 segments was the only independent predictor of cardiac death or nonfatal myocardial infarction (p < 0.001), and was the most powerful multivariate predictor of any cardiac event (p < 0.002). Patients with an abnormal dipyridamole thallium-201 scan had a higher risk of perioperative cardiac death, myocardial infarction (18{\%} vs 2{\%}; p < 0.001), or any perioperative cardiac event (27{\%} vs 6{\%}; p < 0.001) when compared with those with a normal scan. Preoperative changes in anti-ischemic therapy or coronary revascularization in 36 of 72 patients with abnormal dipyridamole thallium-201 studies reduced perioperative death or myocardial infarction from 31{\%} to 6{\%} (p < 0.01), and all cardiac events from 47{\%} to 8{\%} (p < 0.001) compared with those in patients without intervention. Clinical and scintigraphic risk stratification can identify high-risk, major noncardiovascular surgery patients in whom perioperative outcome can benefit from appropriate preoperative therapeutic interventions.",
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