Risk stratification prior to vascular surgery: Does the location of a dipyridamole thallium scintigram defect provide prognostic information?

Tri Thuong Nguyen, Ezra A Amsterdam, Saul Schaefer

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: While the value of myocardial scintigraphy using dipyridamole thallium is accepted for risk assessment prior to vascular surgery, it is unknown whether the location of the thallium abnormalities provides prognostic information. Methods: Records from 435 consecutive patients scheduled for vascular surgery were reviewed and patients with dipyridamole thallium abnormalities involving the anterior distribution (ANTERIOR n = 62), or inferior or inferolateral distribution (INFERIOR n = 105) were assessed for cardiac complications of surgery (death, myocardial infarction, unstable angina or ischemic congestive heart failure). Results: Patients with a normal dipyridamole thallium scintigraphy had few surgical cardiac complications: 2/86 (2%). Patients with an ANTERIOR dipyridamole thallium defect had a 12% incidence of surgical cardiac complications (7/57) without any cardiac deaths, while patients with an INFERIOR dipyridamole thallium defect had a similar incidence of surgical cardiac complications, 18% (18/100; p = 0.65 vs. ANTERIOR) including 4 cardiac deaths. Conclusions: Significant inferior or inferolateral dipyridamole thallium scintigraphy abnormalities are not associated with a lower risk of cardiac complications following vascular surgery than anterior abnormalities. Rather, any clearly abnormal dipyridamole thallium study is a marker for increased risk of perioperative events and may warrant further evaluation and treatment.

Original languageEnglish (US)
Pages (from-to)569-575
Number of pages7
JournalCardiology
Volume88
Issue number6
StatePublished - Oct 1997

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Dipyridamole
Thallium
Blood Vessels
Radionuclide Imaging
Myocardial Perfusion Imaging
Incidence
Unstable Angina
Thoracic Surgery
Heart Failure
Myocardial Infarction

Keywords

  • Dipyridamole
  • Myocardial ischemia
  • Risk assessment
  • Surgery
  • Thallium

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{061c75d3ffac4d87bcf86a631fbd9057,
title = "Risk stratification prior to vascular surgery: Does the location of a dipyridamole thallium scintigram defect provide prognostic information?",
abstract = "Background: While the value of myocardial scintigraphy using dipyridamole thallium is accepted for risk assessment prior to vascular surgery, it is unknown whether the location of the thallium abnormalities provides prognostic information. Methods: Records from 435 consecutive patients scheduled for vascular surgery were reviewed and patients with dipyridamole thallium abnormalities involving the anterior distribution (ANTERIOR n = 62), or inferior or inferolateral distribution (INFERIOR n = 105) were assessed for cardiac complications of surgery (death, myocardial infarction, unstable angina or ischemic congestive heart failure). Results: Patients with a normal dipyridamole thallium scintigraphy had few surgical cardiac complications: 2/86 (2{\%}). Patients with an ANTERIOR dipyridamole thallium defect had a 12{\%} incidence of surgical cardiac complications (7/57) without any cardiac deaths, while patients with an INFERIOR dipyridamole thallium defect had a similar incidence of surgical cardiac complications, 18{\%} (18/100; p = 0.65 vs. ANTERIOR) including 4 cardiac deaths. Conclusions: Significant inferior or inferolateral dipyridamole thallium scintigraphy abnormalities are not associated with a lower risk of cardiac complications following vascular surgery than anterior abnormalities. Rather, any clearly abnormal dipyridamole thallium study is a marker for increased risk of perioperative events and may warrant further evaluation and treatment.",
keywords = "Dipyridamole, Myocardial ischemia, Risk assessment, Surgery, Thallium",
author = "Nguyen, {Tri Thuong} and Amsterdam, {Ezra A} and Saul Schaefer",
year = "1997",
month = "10",
language = "English (US)",
volume = "88",
pages = "569--575",
journal = "Cardiology",
issn = "0008-6312",
publisher = "S. Karger AG",
number = "6",

}

TY - JOUR

T1 - Risk stratification prior to vascular surgery

T2 - Does the location of a dipyridamole thallium scintigram defect provide prognostic information?

AU - Nguyen, Tri Thuong

AU - Amsterdam, Ezra A

AU - Schaefer, Saul

PY - 1997/10

Y1 - 1997/10

N2 - Background: While the value of myocardial scintigraphy using dipyridamole thallium is accepted for risk assessment prior to vascular surgery, it is unknown whether the location of the thallium abnormalities provides prognostic information. Methods: Records from 435 consecutive patients scheduled for vascular surgery were reviewed and patients with dipyridamole thallium abnormalities involving the anterior distribution (ANTERIOR n = 62), or inferior or inferolateral distribution (INFERIOR n = 105) were assessed for cardiac complications of surgery (death, myocardial infarction, unstable angina or ischemic congestive heart failure). Results: Patients with a normal dipyridamole thallium scintigraphy had few surgical cardiac complications: 2/86 (2%). Patients with an ANTERIOR dipyridamole thallium defect had a 12% incidence of surgical cardiac complications (7/57) without any cardiac deaths, while patients with an INFERIOR dipyridamole thallium defect had a similar incidence of surgical cardiac complications, 18% (18/100; p = 0.65 vs. ANTERIOR) including 4 cardiac deaths. Conclusions: Significant inferior or inferolateral dipyridamole thallium scintigraphy abnormalities are not associated with a lower risk of cardiac complications following vascular surgery than anterior abnormalities. Rather, any clearly abnormal dipyridamole thallium study is a marker for increased risk of perioperative events and may warrant further evaluation and treatment.

AB - Background: While the value of myocardial scintigraphy using dipyridamole thallium is accepted for risk assessment prior to vascular surgery, it is unknown whether the location of the thallium abnormalities provides prognostic information. Methods: Records from 435 consecutive patients scheduled for vascular surgery were reviewed and patients with dipyridamole thallium abnormalities involving the anterior distribution (ANTERIOR n = 62), or inferior or inferolateral distribution (INFERIOR n = 105) were assessed for cardiac complications of surgery (death, myocardial infarction, unstable angina or ischemic congestive heart failure). Results: Patients with a normal dipyridamole thallium scintigraphy had few surgical cardiac complications: 2/86 (2%). Patients with an ANTERIOR dipyridamole thallium defect had a 12% incidence of surgical cardiac complications (7/57) without any cardiac deaths, while patients with an INFERIOR dipyridamole thallium defect had a similar incidence of surgical cardiac complications, 18% (18/100; p = 0.65 vs. ANTERIOR) including 4 cardiac deaths. Conclusions: Significant inferior or inferolateral dipyridamole thallium scintigraphy abnormalities are not associated with a lower risk of cardiac complications following vascular surgery than anterior abnormalities. Rather, any clearly abnormal dipyridamole thallium study is a marker for increased risk of perioperative events and may warrant further evaluation and treatment.

KW - Dipyridamole

KW - Myocardial ischemia

KW - Risk assessment

KW - Surgery

KW - Thallium

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