Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery

Journal Article · Thu Jun 01 00:00:00 EDT 1989 · Ann. Intern. Med.; (United States)

DOI:https://doi.org/10.7326/0003-4819-110-11-859· OSTI ID:6078962

Eagle, K A; Coley, C M; Newell, J B; Brewster, D C; Darling, R C; Strauss, H W; Guiney, T E; Boucher, C A

STUDY OBJECTIVE: To determine whether clinical markers and preoperative dipyridamole-thallium imaging are both useful in predicting ischemic events after vascular surgery. Two hundred fifty-four consecutive patients were referred to a nuclear cardiology laboratory before surgery. Forty-four patients had surgery cancelled or postponed after clinical evaluation and dipyridamole-thallium imaging. Surgery was not confirmed for ten. Two hundred patients receiving prompt vascular surgery were the study group. Thirty patients (15%) had early postoperative cardiac ischemic events, with cardiac death in 6 (3%) and nonfatal myocardial infarction in 9 (4.5%). Logistic regression identified five clinical predictors (Q waves, history of ventricular ectopic activity, diabetes, advanced age, angina) and two dipyridamole-thallium predictors of postoperative events. Of patients with none of the clinical variables (n = 64), only 2 (3.1%; 95% CI, 0% to 8%) had ischemic events with no cardiac deaths. Ten of twenty (50%; 95% CI, 29% to 71%) patients with three or more clinical markers had events. Eighteen of one hundred sixteen (15.5%; 95% CI, 7% to 21%) patients with either 1 or 2 clinical predictors had events. Within this group, 2 of 62 (3.2%; 95% CI, 0% to 8%) patients without thallium redistribution had events compared with 16 events in 54 patients (29.6%; 95% CI, 16% to 44%) with thallium redistribution. The multivariate model using both clinical and thallium variables showed significantly higher specificity at equivalent sensitivity levels than models using either clinical or thallium variables alone. Preoperative dipyridamole-thallium imaging appears most useful to stratify vascular patients determined to be at intermediate risk by clinical evaluation.

• Research Organization: Massachusetts General Hospital, Boston (USA)
• OSTI ID: 6078962
• Journal Information: Ann. Intern. Med.; (United States), Vol. 110:11
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
HEART
RADIOISOTOPE SCANNING
ISCHEMIA
DIAGNOSIS
MYOCARDIAL INFARCTION
VASCULAR DISEASES
SURGERY
ELECTROCARDIOGRAMS
FORECASTING
MULTIVARIATE ANALYSIS
PATIENTS
RISK ASSESSMENT
THALLIUM ISOTOPES
VASODILATORS
BODY
CARDIOVASCULAR AGENTS
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
COUNTING TECHNIQUES
DIAGRAMS
DISEASES
DRUGS
ISOTOPES
MATHEMATICS
MEDICINE
ORGANS
STATISTICS
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