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International Angiology 1999 June;18(2):158-62

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Role of dipyridamole myocardial scintigraphy in abdominal aortic aneurysm repair

Matsumoto K., Nakamaru M., Obara H., Hayashi S., Harada H., Kitajima M.

From the Department of Surgery, Keio University School of Medicine, Tokyo, Japan


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Background. We eval­u­at­ed the use­ful­ness of pre­op­er­a­tive dip­y­rid­a­mole myo­car­dial scin­tig­ra­phy (DMS) under low-level exer­cise in pre­dict­ing post­op­er­a­tive car­diac prob­lems in ­patients under­go­ing elec­tive abdom­i­nal aor­tic aneu­rysm (AAA) ­repair.
Methods. Experi­men­tal ­design: ret­ro­spec­tive com­par­i­son of ­patients who did and did not under­go the investigation pre­op­er­a­tive­ly. Set­ting:­ at the Keio Uni­ver­sity Hos­pi­tal and the Kawa­sa­ki City Hos­pi­tal. ­Patients: ­eighty-five ­patients who had abdominal aortic aneurysm ­repair con­sec­u­tive­ly from 1986 to 1990 with­out under­go­ing dipyridamole myocardial scintigraphy pre­op­er­a­tive­ly were com­pared with 118 ­patients who under­went the ­repair con­sec­u­tive­ly from 1991 to 1997 after hav­ing had pre­op­er­a­tive scintigraphy.
Meas­urements: post­op­er­a­tive occur­renc­es of myo­car­dial infarc­tion and angi­na pec­tor­is in the two ­groups of ­patients were com­pared sta­tis­ti­cal­ly.
­Results. In the group not hav­ing scintigraphy, car­diac ­events ­occurred in 12 pa­tients (14.1%) after ­repair. Ten ­patients had a myo­car­dial infarc­tion; six died with­in 30 days of oper­a­tion and four died after the 31st post­op­er­a­tive day. The other two ­patients had angi­na pec­tor­is; both sur­vived. In the group hav­ing scintigraphy, there were no post­op­er­a­tive car­diac ­events (p<0.0001). Sev­en­teen ­patients had pos­i­tive ­results on pre­op­er­a­tive scintigraphy. Seven of them had undergone cor­o­nary ­artery ­bypass graft­ing and five cor­o­nary angio­plas­ty ­before the ­repair. In the five other ­patients, scintigraphy, was found to have yield­ed false pos­i­tive ­results.
Con­clu­sions. Dypiridamole myocardial scintigraphy is an accu­rate pre­dic­tor of post­op­er­a­tive myo­car­dial infarc­tion and angi­na pec­tor­is in ­patients being eval­u­at­ed for elec­tive abdominal aortic aneurysm repair and ­should be used rou­tine­ly.

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