Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery

Journal Article · Thu Feb 14 04:00:00 EST 1985 · N.Engl. J. Med.; (United States)

DOI:https://doi.org/10.1056/NEJM198502143120701· OSTI ID:5522434

Boucher, C A; Brewster, D C; Darling, R C; Okada, R D; Strauss, H W; Pohost, G M

To evaluate the severity of coronary artery disease in patients with severe peripheral vascular disease requiring surgery, preoperative dipyridamole-thallium imaging was performed 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.

• Research Organization: Massachusetts General Hospital, Boston
• OSTI ID: 5522434
• Journal Information: N.Engl. J. Med.; (United States), Journal Name: N.Engl. J. Med.; (United States) Vol. 312:7; ISSN NEJMA
• Country of Publication: United States
• Language: English

Related Subjects

550601* -- Medicine-- Unsealed Radionuclides in Diagnostics
62 RADIOLOGY AND NUCLEAR MEDICINE
ARTERIES
BLOOD VESSELS
BODY
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
CORONARIES
COUNTING TECHNIQUES
DIAGNOSIS
DISEASES
IMAGES
ISOTOPES
MEDICINE
ORGANS
PATIENTS
RADIOISOTOPE SCANNING
SURGERY
THALLIUM ISOTOPES