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Study Year Group Method Findings Comments Kayano (61) 2009 211, aortic surgery Dipyridamole gated SPECT Multiple predictive scan and gated markers Only end-systolic volume on gated was multivariate predictor Stratmann (62) 1996 285, nonvascular Dipyridamole sestamibi SPECT Abnormal scan, Goldman class, only predictors for major surgery 1% event rate if normal scan Low events in minor surgery regardless of scan No value in low-clinical-risk group having minor surgery Van Damme (63) 1997 156, vascular Dobutamine sestamibi SPECT Abnormal scan; relative risk, 7.4; negative predictive value, 0.97 Nonpredictive if no clinical CAD markers Brown (1) 1993 231, vascular and nonvascular Dipyridamole thallium planar Reversible defects, diabetes, multivariate predictors Extent of redistribution was important Younis (64) 1994 161, major noncardiac, intermediate/high CAD likelihood Dipyridamole thallium planar Multiple defects only independent predictor of death or MI; abnormal scan 27% vs. 6% events Intervention or change in treatment reduced risk Kresowik (65) 1993 190, vascular Dipyridamole thallium planar Redistribution in 45% and 46% whether CAD clinically apparent or not Left main coronary artery/3-vessel disease by catheterization in 13% Fleisher (66) 1999 6,895, vascular, Medicare MPI or dobutamine stress echocardiography 7% mortality, aortic surgery 16% 1-y mortality, infrainguinal surgery Stress testing with revascularization strategy reduced mortality at 30 d and 1 y Koutelou (29) 1995 106, vascular Adenosine thallium SPECT No events if no ischemia vs. 11% if ischemia 54% had abnormal scans; 82% had reversible defects Low positive predictive value Baron (67) 1994 457, abdominal aortic aneurysm Dipyridamole thallium SPECT MPI not predictive of events Only age and definite CAD were predictive Lette (68) 1992 360 total, 194 surgical (vascular or major general) with normal scans or fixed defects Dipyridamole thallium planar 1% risk of preoperative cardiac events 1.4% cardiac morbidity at 6 mo 15× noncardiac vs. cardiac risk Argued against angiography/revascularization in such patients Mangano (69) 1991 60, vascular Dipyridamole thallium planar Redistribution not correlated with perioperative events Included continuous monitoring Marshall (28) 1995 122, vascular Adenosine thallium planar in 108 patients Adenosine sestamibi planar in 18 patients Number of reversible defects only multivariate predictor of events Only prior heart failure predicted perioperative heart failure Lette (30) 1992 360, noncardiac vascular or major general Dipyridamole thallium planar 1% perioperative events 3.5% 15 mo if normal scan or fixed defects 17% perioperative, 23% late events if redistribution Clinical variables were not predictive; risk proportional to extent and severity of ischemia Fleisher (24) 1995 180, noncardiac Dipyridamole thallium planar Strongly positive defect by quantitation only result with worse long-term survivalLow positive predictive value for perioperative events Performed ambulatory EKG as well—similar prediction Lette (27) 1992 355, vascular and major general Dipyridamole thallium planar Three-step method, 3 segments only Normal→1.3% event rate Added clinical markers only if intermediate scan results Left main or multivessel (extensive ischemia)→52% events; then, age > 70 y, diabetes, 1 vs. 2 segments→5%–36% risk Coley (70) 1992 100, nonvascular Dipyridamole thallium planar For age > 70 y or history of heart failure, 3% vs. 33% had events based on redistributionFor age ≤ 70 y, no heart failure→no events Nearly half of patients were low risk by clinical variables Hashimoto (71) 2007 1,220, intermediate, low risk, noncardiac Dipyridamole thallium SPECT SPECT predictive in intermediate risk only, not predictive in low-risk surgery Functional data were of incremental value in intermediate clinical and surgical risk Bai (72) 2008 284, diabetes without chest pain, noncardiac surgery Dipyridamole SPECT Low events in normal scans; abnormal scan increases risk proportional to extent of surgery No clinical predictors except duration of diastolic murmur Cutler (73) 1992 327, vascular Dipyridamole thallium planar Death or MI, 14% if redistribution Different predictor for late vs. early events 1% if normal scan 15% late events (mean, 31 mo) Fixed defects best predictor of late events Cutler (74) 1987 116, aortic Dipyridamole thallium planar MI: 0/65 normal scanMI: 8/31 abnormal scan Early study was more predictive than all symptoms Eagle (75) 1989 200, vascular Dipyridamole thallium planar Thallium redistribution stratified Was less useful in high- or low-clinical-risk group intermediate-risk group into 3% vs. 30% event rate Younis (76) 1990 111, vascular Dipyridamole thallium planar 7% vs. 0%, death/MI perioperative for abnormal vs. normal scan At mean 18 mo, 17% vs. 5.6% Redistribution was predictive only of late events McFalls (26) 1993 116, nonvascular Exercise thallium SPECT Angina, CAD signs, abnormal thallium, low ejection fraction correlated with postoperative MI Angina, fixed defects, were independent predictors Hashimoto (25) 2003 481, noncardiac high or intermediate risk Dipyridamole tetrofosmin and sestamibi SPECT Perfusion and function results both independent predictors among clinical variablesQuantitation of perfusion and function predictive Gated helped stratify only patients with normal perfusion
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- Article
- Abstract
- THE NATURE OF SURGICAL RISK ASSESSMENT
- DEFINITION OF RISK
- PATHOPHYSIOLOGY OF PERIOPERATIVE MI: DETECTION OF PATHOLOGIC SUBSTRATE BY MPI
- PERFORMANCE OF MPI FOR PERIOPERATIVE RISK STRATIFICATION THROUGH THE DECADES
- IMAGE INTERPRETATION: SCAN INDICATORS OF PERIOPERATIVE RISK
- PROGNOSTIC IMAGING CONSIDERATIONS FROM NONSURGICAL POPULATIONS WITH POTENTIAL APPLICATION TO PREOPERATIVE RISK STRATIFICATION
- PREOPERATIVE RISK STRATIFICATION IN SPECIAL POPULATIONS
- IMPORTANCE OF DYSPNEA AND EXERCISE TOLERANCE
- COMPARISON OF MPI TO OTHER MODALITIES
- INTEGRATING MPI INTO PATIENT MANAGEMENT: RECOMMENDATIONS FROM PRACTICE GUIDELINES
- KEY POINTS AND CONCLUSION
- Footnotes
- REFERENCES
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