Myocardial perfusion scintigraphy in patients undergoing major non-vascular abdominal surgery.

摘要

The prognostic value of myocardial perfusion scintigraphy is beginning to be recognised in patients undergoing cardiovascular surgery. The aim of this prospective study was to assess the predictive value of scintigraphy in elderly patients undergoing major non-vascular abdominal surgery. Adenosine stress thallium-201 (201Tl) single-photon emission tomography (SPET) was employed for imaging using a standard protocol. Patients over the age of 60 years (n = 55) with an intermediate to high likelihood of coronary artery disease were evaluated prospectively. The clinical outcome variables analysed were cardiac mortality and major cardiac morbidity occurring within 30 days of surgery. Cardiac events were cardiac death (n = 5), angina pectoris (n = 5), nonfatal mycardial infarction (n = 1), acute left ventricular failure (n = 2) and arrhythmias requiring treatment (n = 4). All cardiac events occurred in the first 10 postoperative days except one cardiac death which happened on the 29th postoperative day. Patients with an abnormal 201Tl SPET scan had a higher risk of postoperative death (4 vs 1) or any postoperative cardiac event (13 patients vs 4 patients; P < 0.0001) when compared with those with a normal scan. The sensitivity, specificity and positive predictive value of 201Tl imaging for perioperative ischaemia and adverse outcomes were 76%, 82% and 65%, respectively. The occurrence of an intraoperative event (P < 0.02) and the length of surgery (P < 0.01) were also predictors of a postoperative cardiac event. Clinical risk variables and an abnormal electrocardiogram in isolation were poor predictors. In conclusion, preoperative myocardial perfusion scintigraphy is a valuable technique for identifying elderly patients with a high risk for cardiac events when undergoing major non-vascular abdominal surgery.