Prediction of late cardiac events by dipyridamole thallium imaging in patients undergoing elective vascular surgery

Robert Hendel, Steven S. Whitfield, Bernard J. Villegas, Bruce S. Cutler, Jeffrey A. Leppo

Research output: Contribution to journalArticle

97 Citations (Scopus)

Abstract

Dipyridamole thallium scintigraphy has previously been shown to have prognostic value in the preoperative assessment of patients scheduled to undergo vascular surgery, but its effect on the long-term outcome is less well-defined. In the largest series to date, dipyridamole thallium scanning was performed in 360 patients before elective vascular surgery and survivors were followed for a mean of 31 months. In the 327 patients who underwent vascular surgery, operative death and nonfatal myocardial infarction occurred in 4.9 and 6.7%, respectively. A cardiac event (nonfatal myocardial infarction or cardiac death) occurred in 14.4% of patients with a transient thallium defect, as opposed to 1% with a normal scan (p < 0.001). Logistic regression analysis revealed that the best predictor of a perioperative event was the presence of a reversible thallium defect, elevating the risk by 4.3-fold. Late cardiac events occurred in 53 (15.2%) surgical survivors or nonsurgically treated patients. Patients with a fixed perfusion abnormality had a 24% late event rate, compared with 4.9% in those with a normal dipyridamole thallium study (p < 0.01). Cox analysis demonstrated that a fixed thallium defect was the strongest factor for predicting a late event and increased the relative risk by almost fivefold. A history of congestive heart failure was the only significant variable that contributed additional value to that of a fixed defect alone. Life-table analysis confirmed the strong relation of a fixed defect to cardiac event free survival (p < 0.0001). Therefore, dipyridamole thallium imaging demonstrates valuable prognostic information for long-term event-free survival in a large population of patients undergoing vascular surgery and provides important risk stratification data for the perioperative period.

Original languageEnglish
Pages (from-to)1243-1249
Number of pages7
JournalThe American journal of cardiology
Volume70
Issue number15
DOIs
StatePublished - Nov 15 1992
Externally publishedYes

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Dipyridamole
Thallium
Blood Vessels
Disease-Free Survival
Survivors
Myocardial Infarction
Perioperative Period
Life Tables
Radionuclide Imaging
Heart Failure
Perfusion
Logistic Models
Regression Analysis
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prediction of late cardiac events by dipyridamole thallium imaging in patients undergoing elective vascular surgery. / Hendel, Robert; Whitfield, Steven S.; Villegas, Bernard J.; Cutler, Bruce S.; Leppo, Jeffrey A.

In: The American journal of cardiology, Vol. 70, No. 15, 15.11.1992, p. 1243-1249.

Research output: Contribution to journalArticle

Hendel, Robert ; Whitfield, Steven S. ; Villegas, Bernard J. ; Cutler, Bruce S. ; Leppo, Jeffrey A. / Prediction of late cardiac events by dipyridamole thallium imaging in patients undergoing elective vascular surgery. In: The American journal of cardiology. 1992 ; Vol. 70, No. 15. pp. 1243-1249.
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abstract = "Dipyridamole thallium scintigraphy has previously been shown to have prognostic value in the preoperative assessment of patients scheduled to undergo vascular surgery, but its effect on the long-term outcome is less well-defined. In the largest series to date, dipyridamole thallium scanning was performed in 360 patients before elective vascular surgery and survivors were followed for a mean of 31 months. In the 327 patients who underwent vascular surgery, operative death and nonfatal myocardial infarction occurred in 4.9 and 6.7{\%}, respectively. A cardiac event (nonfatal myocardial infarction or cardiac death) occurred in 14.4{\%} of patients with a transient thallium defect, as opposed to 1{\%} with a normal scan (p < 0.001). Logistic regression analysis revealed that the best predictor of a perioperative event was the presence of a reversible thallium defect, elevating the risk by 4.3-fold. Late cardiac events occurred in 53 (15.2{\%}) surgical survivors or nonsurgically treated patients. Patients with a fixed perfusion abnormality had a 24{\%} late event rate, compared with 4.9{\%} in those with a normal dipyridamole thallium study (p < 0.01). Cox analysis demonstrated that a fixed thallium defect was the strongest factor for predicting a late event and increased the relative risk by almost fivefold. A history of congestive heart failure was the only significant variable that contributed additional value to that of a fixed defect alone. Life-table analysis confirmed the strong relation of a fixed defect to cardiac event free survival (p < 0.0001). Therefore, dipyridamole thallium imaging demonstrates valuable prognostic information for long-term event-free survival in a large population of patients undergoing vascular surgery and provides important risk stratification data for the perioperative period.",
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