Document Detail


Dipyridamole-thallium scintigraphy and gated radionuclide angiography to assess cardiac risk before abdominal aortic surgery.
MedLine Citation:
PMID:  8107716     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Because many patients with atherosclerotic disease of the abdominal aorta also have coronary artery disease, assessment of cardiac risk before abdominal aortic surgery has received much attention. Our prospective study was designed to identify predictors of cardiac risk in consecutive patients evaluated preoperatively with dipyridamole-thallium single-photon-emission computed tomography (SPECT) to assess myocardial perfusion and radionuclide angiography to measure left ventricular ejection fraction. METHODS: Clinical and scintigraphic data were collected prospectively during hospitalization in 457 consecutive patients undergoing elective abdominal aortic surgery. Adverse cardiac outcomes were predicted with multivariate analyses. RESULTS: Eighty-six patients (19 percent) had one or more of the following postoperative complications: prolonged myocardial ischemia (61 patients), myocardial infarction (22), congestive heart failure (20), and severe ventricular tachyarrhythmia (2). Twenty patients died postoperatively (4.4 percent), half of them from cardiac causes. Information about myocardial perfusion obtained from dipyridamole-thallium SPECT did not accurately predict adverse cardiac outcomes. The best correlates of cardiac complications were definite clinical evidence of coronary artery disease (odds ratio, 2.6; 95 percent confidence interval, 1.6 to 4.3) and age greater than 65 years (odds ratio, 2.3; 95 percent confidence interval, 1.4 to 3.6). Measurement of the ejection fraction was useful only in the prediction of left ventricular failure. Age greater than 65 years was the only predictor of death (odds ratio, 26.4; 95 percent confidence interval, 3.5 to 200.0). CONCLUSIONS: The presence of definite clinical evidence of coronary artery disease and older age were the most important preoperative predictors of an adverse cardiac outcome after abdominal aortic surgery. These results suggest that the routine use of dipyridamole-thallium SPECT and radionuclide angiography for screening before abdominal aortic surgery may not be justified.
Authors:
J F Baron; O Mundler; M Bertrand; E Vicaut; E Barr?; G Godet; C M Samama; P Coriat; E Kieffer; P Viars
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The New England journal of medicine     Volume:  330     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1994 Mar 
Date Detail:
Created Date:  1994-03-21     Completed Date:  1994-03-21     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  663-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, H?pital Piti?-Salp?tri?re, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aorta, Abdominal / surgery*
Aortic Diseases / surgery
Coronary Circulation
Dipyridamole / diagnostic use*
Gated Blood-Pool Imaging*
Heart Diseases / etiology,  mortality,  radionuclide imaging*
Humans
Middle Aged
Multivariate Analysis
Odds Ratio
Postoperative Complications / etiology,  mortality
Risk Factors
Stroke Volume
Surgical Procedures, Elective
Thallium Radioisotopes / diagnostic use
Tomography, Emission-Computed, Single-Photon
Chemical
Reg. No./Substance:
0/Thallium Radioisotopes; 58-32-2/Dipyridamole
Comments/Corrections
Comment In:
N Engl J Med. 1994 Aug 18;331(7):480   [PMID:  8068148 ]
N Engl J Med. 1994 Mar 10;330(10):707-9   [PMID:  8107722 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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