ORIGINAL ARTICLES   

International Angiology 1998 September;17(3):171-8

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

The predictive value of dipyridamole-thallium scintigraphy for cardiac risk assessment before major vascular surgery

Klonaris Ch. N., Bastounis E. A., Xiromeritis N. C., Balas P. E.

From the First Department of Surgery, Division of Vascular Surgery, Medical School, University of Athens, Greece

Background. We pros­pec­tive­ly exam­ined the abil­ity of dip­y­rid­a­mole thal­li­um scin­tig­ra­phy (DTS), as a pre­op­er­a­tive screen­ing test, to pre­dict post­op­er­a­tive car­diac com­pli­ca­tions in ­patients under­go­ing periph­er­al arte­ri­al oper­a­tions.
Methods. From November 1993 to November 1995, a DTS study was rou­tine­ly per­formed pre­op­er­a­tive­ly in 167 con­sec­u­tive ­patients who under­went arte­ri­al oper­a­tions in our hos­pi­tal. The cli­ni­cians were blind­ed to DTS ­results. The type of oper­a­tion was: carotid endar­te­rec­to­my (n=53), abdom­i­nal aor­tic aneu­rysm ­repair (n=45), aor­to­bif­e­mo­ral ­bypass (n=31), femor­o­pop­li­teal ­bypass (n=32) and oth­ers (n=6). Clinical and scin­ti­graph­ic data were col­lect­ed and ana­lyzed uni- and mul­ti­var­i­ant­ly in order to iden­ti­fy those var­i­ables that cor­re­late with post­op­er­a­tive car­diac com­pli­ca­tions.
Results. Fifthteen ­adverse car­diac ­events (three ­deaths, five myo­car­dial infarc­tions, seven ­unstable angi­nas) ­occurred post­op­er­a­tive­ly among 167 ­patients (mor­tal­ity: 1.8%, mor­bid­ity: 7.2%). Forty-four ­patients (26.3%) had a nor­mal scin­ti­graph­ic study, sixty (35,9%) had fixed ­defects and sixty-three (37.7%) had rever­sible ­defects. The most pow­er­ful pre­dic­tive fac­tors of car­diac com­pli­ca­tions in the mul­ti­var­i­ate anal­y­sis were the syn­chro­nous exis­tence of three mark­ers of cor­o­nary ­artery dis­ease (angi­na pec­tor­is, pre­vi­ous myo­car­dial infarc­tion, Q sign on ECG) and the pres­ence of a rever­sible ­defect in the ante­ri­or seg­ment of the left ven­tri­cle on DTS study.
Conclusions. This study dem­on­strates that the care­ful and ­detailed clin­i­cal exam­ina­tion is of par­a­mount impor­tance in detect­ing “high risk” ­patients and that DTS ­should be per­formed as a sup­ple­men­tary test since it ­offers sig­nif­i­cant infor­ma­tion and fur­ther clas­si­fies ­patients of inter­me­di­ate risk to devel­op post­op­er­a­tive car­diac com­pli­ca­tions.