Preoperative Cardiac Evaluation by Dipyridamole Thallium‐201 Myocardial Perfusion Scan Provides no Benefit in Patients with Abdominal Aortic Aneurysm

Shin, Sung; Kwon, Tae-Won; Cho, Yong‐Pil; Lee, Jong‐Young; Park, Hojong; Han, Youngjin

doi:10.1007/s00268-013-2200-9

Cited by 4 publications

(4 citation statements)

References 32 publications

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“…5 Another study suggested that incorporation of MPI may improve perioperative risk assessment of patients with obstructive disease upon coronary computed tomography angiography. 23 However, other studies have shown that routine use of MPI before abdominal aortic surgery did not predict the risk of cardiac complications 26,27 and did not improve patient risk classification beyond essential assessment using age, RCRI, and surgical priority. 28 However, These previous studies were limited by relatively small sample sizes and low event rates, inclusion of mainly patients undergoing relatively high-risk vascular surgery, and the use of outdated perfusion imaging techniques and perioperative management.…”

Section: Discussionmentioning

confidence: 98%

Association Between Preoperative Myocardial Perfusion Imaging and Cardiac Events after Elective Noncardiac Surgery

Wee

Lee

Jun

et al. 2023

Preprint

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Background There remains a lack of robust evidence regarding the prognostic value of myocardial perfusion imaging (MPI) before noncardiac surgery in large and diverse patient populations. Methods This retrospective observational cohort study from single, tertiary, high surgical volume center in South Korea included 82,441 patients aged >40 years who underwent MPI using pharmacologic stress single photon emission computed tomography within 6 months before elective noncardiac surgery from January 2000 to December 2021. Results of MPI were classified as abnormal (any fixed or reversible perfusion defect) vs normal MPI before noncardiac surgery. The primary outcome was a composite of cardiac death or myocardial infarction within 30 days. Results Among the 82441 patients (mean±standard deviation age, 65.7±9.6 years; 47417 [57.5%] men), 184 (0.2%) experienced cardiac death or myocardial infarction within 30 days after noncardiac surgery. MPI were abnormal in 5603 patients (6.8%). Compared with a normal MPI, an abnormal MPI had a higher risk of the primary outcome (crude incidence, 1.2% vs 0.1%; adjusted odds ratio, 4.64; 95% confidence interval, 3.29-6.50; P<.001). The presence of an abnormal MPI improved discrimination for the primary outcome (area under the receiver operating characteristic curve with MPI vs without MPI (0.77 vs 0.73; P<0.001) and significantly increased net reclassification improvement (0.26; 95% confidence interval, 0.11-0.40; P<.001). Among patients with an abnormal MPI, 378 (6.7%) underwent pre-operative coronary revascularization; however, this was not associated with a lower risk of the primary outcome (P=.56). Conclusion An abnormal myocardial perfusion imaging appeared to be an important risk factor for adverse postoperative events and provided additional prognostic value for patients undergoing noncardiac surgery. Nevertheless, preoperative MPI was limited by its low positive predictive value for postoperative cardiac events, leading to potentially unnecessary coronary revascularization procedures with unproven prognostic value.

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Section: Discussionmentioning

confidence: 98%

Association Between Preoperative Myocardial Perfusion Imaging and Cardiac Events after Elective Noncardiac Surgery

Wee

Lee

Jun

et al. 2023

Preprint

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“…On the other hand, early studies reported dipyridamole-thallium scanning as a valuable predictor of outcomes after AAA surgery [44,45]. However, later studies indicated that dipyridamole-thallium scan was not superior to standard examinations [46,47], and many patients experienced side effects such as dizziness or chest tightness [48]. In contrast to stress testing, the troponin test can be performed with a simple blood test and has minimal associated risks.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Injury after Non-Cardiac Surgery in Patients Who Underwent Open Repair for Abdominal Aortic Aneurysm: A Retrospective Study

Bae,

Kim,

Yoon

et al. 2024

JCM

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Background: Myocardial injury after non-cardiac surgery (MINS) has been known to be associated with mortality in various surgical patients; however, its prognostic role in abdominal aortic aneurysm (AAA) open repair remains underexplored. This study aimed to investigate the role of MINS as a predictor of mortality in patients who underwent AAA open repair. Methods: This retrospective study investigated 352 patients who underwent open repair for non-ruptured AAA. The predictors of 30-day and 1-year mortalities were investigated using logistic regression analysis. Results: MINS was diagnosed in 41% of the patients after AAA open repair in this study. MINS was an independent risk factor of 30-day mortality (odds ratio [OR]: 10.440, 95% confidence interval [CI]: 1.278–85.274, p = 0.029) and 1-year mortality (OR: 5.189, 95% CI: 1.357–19.844, p = 0.016). Kaplan–Meier survival curves demonstrated significantly lower overall survival rates in patients with MINS compared to those without MINS (p = 0.003). Conclusion: This study revealed that MINS is a common complication after AAA open repair and is an independent risk factor of 30-day and 1-year mortalities. Patients with MINS have lower overall survival rates than those without MINS.

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“…Coronary artery disease is the most important cause of morbidity and mortality in patients with aortic aneurysms, during the postoperative period of aortic aneurysms [7,8]. However, it is difficult to predict morbidity and mortality only by evaluating coronary artery stenosis [9]. These unsatisfactory results may be related to an incomplete knowledge of coronary anatomy in patients with aortic aneurysms.…”

Section: Introductionmentioning

confidence: 99%

Effects of the topographical extent of coronary artery ectasia on coronary blood flow in patients with aortic aneurysms

et al. 2014

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Aortic aneurysms are associated with coronary artery ectasia (CAE). However, the relation between the extent of CAE and coronary blood flow in patients with aortic aneurysms is not fully understood. This study was undertaken to assess the angiographic characteristics and effects of the topographical extent of CAE on coronary blood flow in patients with aortic aneurysms. This study consisted of 93 consecutive patients with aortic aneurysms (AA group) and 79 patients without aortic aneurysms who had angiographically normal coronary arteries as the control group (Control group). Coronary flow velocity was determined using the thrombolysis in myocardial infarction frame count (TFC) and the topographical extent of CAE was assessed. In the AA group, 43 patients (46.2 %) had significant coronary artery stenosis and 37 patients (40.2 %) had diffuse CAE. TFC was significantly higher in the AA group than in the control group in all 3 coronary arteries. Furthermore, mean corrected TFC (CTFC) was significantly higher in the AA group than in the control group (40.1 ± 10.7 vs. 25.8 ± 6.5, p < 0.001). In the AA group, mean CTFC in patients with diffuse CAE was significantly higher than that in patients with segmental CAE (50.2 ± 8.7 vs. 33.6 ± 5.2, p < 0.001). The mean CTFC correlated positively with the topographical extent of CAE. Many patients with aortic aneurysms were accompanied with angiographic coronary artery stenosis and CAE. Furthermore, patients with aortic aneurysms had higher CTFC than those without aortic aneurysms and it was primarily driven by more frequent prevalence of diffuse CAE.

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Preoperative Cardiac Evaluation by Dipyridamole Thallium‐201 Myocardial Perfusion Scan Provides no Benefit in Patients with Abdominal Aortic Aneurysm

Abstract: Preoperative dipyridamole thallium-201 myocardial perfusion scans were ineffective in predicting postoperative cardiac complications in AAA patients. These results suggest that the routine use of these tests for preoperative screening of patients undergoing AAA repair may not be warranted.

Cited by 4 publications

References 32 publications

Association Between Preoperative Myocardial Perfusion Imaging and Cardiac Events after Elective Noncardiac Surgery

Association Between Preoperative Myocardial Perfusion Imaging and Cardiac Events after Elective Noncardiac Surgery

Myocardial Injury after Non-Cardiac Surgery in Patients Who Underwent Open Repair for Abdominal Aortic Aneurysm: A Retrospective Study

Effects of the topographical extent of coronary artery ectasia on coronary blood flow in patients with aortic aneurysms

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