Pre-operative cardiac risk stratification for noncardiac surgery in cancer patients using myocardial perfusion scintigraphy.

Aims Cancer patients are at a higher risk for any cardiac event during and post surgery, due to an altered coagulation state and anaemia, and can have additive effect if the patient had previous history of any cardiac event or risk factor for coronary artery disease such as hypertension and diabetes. The objective of this study was evaluate the usefulness of gated myocardial perfusion scintigraphy with pharmacological stress in determining the frequency of cardiac events associated with non-cardiac surgery in cancer patients. Methods 100 consecutive patients, who were being planned for the oncological surgery, were enrolled in this study for preoperative gated myocardial perfusion scintigraphy using 99mTc-sestamibi with adenosine stress. After acquiring the data, perfusion images were reconstructed and analysed using visual assessment as well as QPS program and summed stress score (SSS) was obtained. Based on visual assessment and SSS, we divided patients into low- and high-risk groups. Postoperative follow-up of the patients was done through internal medicine clinics. Results Out of 100 patients, 57 were female and 43 male with a mean age 61.25 years. Sixty-three (63%) had a history of diabetes, 73% hypertension, 34% were known smokers while 42% had a family history of coronary artery disease and 15 patients has CAD. 61% fell into the low-risk group and thirty-nine (39%) in the high-risk group. In the low-risk 1 patient (1.63%) needed inotropic support postoperatively. In the high-risk group, 6 (15.38%) patients had cardiac events postoperatively. Subset-analysis of these showed; 3 (7.69%) had an episode of angina prior to discharge, 2 (5.12%) died with cardiac-arrest due to myocardial infraction (MI) and 1 (2.56%) needed inotropic support postoperatively and surgery was deferred in 4 patients due to their very low LVEF and high SSS. These 4 patients were further evaluated by cardiologist for future management. Conclusion In low-risk group patients, stress myocardial perfusion scintigraphy has a high negative predictive value for peri- and postoperative cardiac events in cancer patients. While patients with cancer and labelled as high-risk on myocardial perfusion imaging, whether demonstrating scar or ischaemia, should prompt appropriate peri- and post-operative management to minimize major cardiac events. [ABSTRACT FROM AUTHOR]