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Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery.
- Source :
-
The New England journal of medicine [N Engl J Med] 1985 Feb 14; Vol. 312 (7), pp. 389-94. - Publication Year :
- 1985
-
Abstract
- To evaluate the severity of coronary artery disease in patients with severe peripheral vascular disease requiring operation, we performed preoperative dipyridamole-thallium imaging in 54 stable patients with suspected coronary artery disease. Of the 54 patients, 48 had peripheral vascular surgery as scheduled without coronary angiography, of whom 8 (17 per cent) had postoperative cardiac ischemic events. The occurrence of these eight cardiac events could not have been predicted preoperatively by any clinical factors but did correlate with the presence of thallium redistribution. Eight of 16 patients with thallium redistribution had cardiac events, whereas there were no such events in 32 patients whose thallium scan either was normal or showed only persistent defects (P less than 0.0001). Six other patients also had thallium redistribution but underwent coronary angiography before vascular surgery. All had severe multivessel coronary artery disease, and four underwent coronary bypass surgery followed by uncomplicated peripheral vascular surgery. These data suggest that patients without thallium redistribution are at a low risk for postoperative ischemic events and may proceed to have vascular surgery. Patients with redistribution have a high incidence of postoperative ischemic events and should be considered for preoperative coronary angiography and myocardial revascularization in an effort to avoid postoperative myocardial ischemia and to improve survival. Dipyridamole-thallium imaging is superior to clinical assessment and is safer and less expensive than coronary angiography for the determination of cardiac risk.
- Subjects :
- Aged
Angiography
Coronary Angiography
Coronary Artery Bypass
Coronary Disease surgery
Female
Humans
Male
Middle Aged
Postoperative Complications prevention & control
Radionuclide Imaging
Risk
Coronary Disease diagnostic imaging
Dipyridamole
Preoperative Care
Radioisotopes
Thallium
Vascular Surgical Procedures
Subjects
Details
- Language :
- English
- ISSN :
- 0028-4793
- Volume :
- 312
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- The New England journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 3871502
- Full Text :
- https://doi.org/10.1056/NEJM198502143120701