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Prognostic value of stress CMR and SPECT-MPI in patients undergoing intermediate-to-high-risk non-cardiac surgery.

Authors :
Fazzari, Fabio
Lisi, Costanza
Catapano, Federica
Cannata, Francesco
Brilli, Federica
Figliozzi, Stefano
Bragato, Renato Maria
Stefanini, Giulio Giuseppe
Monti, Lorenzo
Francone, Marco
Source :
La Radiologia Medica; Oct2024, Vol. 129 Issue 10, p1485-1498, 14p
Publication Year :
2024

Abstract

Purpose: The objective of this study was to investigate the role of myocardial perfusion imaging (MPI) stress tests using stress cardiac magnetic resonance (sCMR) and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in non-cardiac surgery (NCS) pre-operatory management. Materials and methods: This monocentric retrospective study enrolled patients with coronary artery disease or a minimum of two cardiovascular risk factors undergoing intermediate-to-high-risk non-cardiac surgeries. The primary composite endpoint comprised cardiac death, cardiogenic shock, acute coronary syndromes (ACS), and cardiogenic pulmonary edema occurring within 30 days after surgery, while the secondary endpoint was ACS. Results: A total of 1590 patients were enrolled; among them, 669 underwent a MPI stress test strategy (sCMR: 287, SPECT-MPI: 382). The incidence of 30-day cardiac events was lower in the stress-tested group compared to the non-stress-tested group (1.2% vs. 3.4%; p 0.006). Adopting a stress test strategy showed a significant reduction in the risk of the composite endpoint (OR: 0.33, 95% CI: 0.15–0.76, p 0.009) and ACS (OR: 0.41, 95% CI: 0.17–0.98, p 0.046) at multivariable analysis, with similar cardiac events rate between stress CMR and SPECT (1.1% vs. 1.3%, p 0.756). Stress CMR showed a greater accuracy to predict coronary artery revascularizations (sCMR c-statistic: 0.95, ischemic cut-point: 5.5%; SPECT c-statistic: 0.85, ischemic cut-point: 7.5%). Conclusion: Stress test strategy is related to a lower occurrence of cardiac events in high-risk patients scheduled for intermediate-to-high-risk non-cardiac surgeries. Both sCMR and SPECT-MPI comparably reduce the likelihood of cardiac complications, albeit sCMR offers greater accuracy in predicting coronary artery revascularization. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
00338362
Volume :
129
Issue :
10
Database :
Complementary Index
Journal :
La Radiologia Medica
Publication Type :
Academic Journal
Accession number :
180268726
Full Text :
https://doi.org/10.1007/s11547-024-01876-x