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Optimizing Preoperative Evaluation of Cardiac Risk

Kim A. Eagle, MD; Daniel E. Singer, MD; David C. Brewster, MD; R. Clement Darling, MD; Albert G. Mulley, MD; Charles A. Boucher, MD

JAMA. 1987;257(16):2185-2189.

Abstract
Dipyridamole-thallium imaging has been suggested as a method of preoperatively assessing cardiac risk in patients undergoing major surgery. To define more clearly its proper role in preoperative assessment, we prospectively evaluated 111 patients undergoing vascular surgery. In the first set of 61 patients, our data confirmed the value of preoperative dipyridamole-thallium scanning in identifying the patients who suffered postoperative ischemic events. Events occurred in eight of 18 patients with reversible defects on preoperative imaging, compared with no events in 43 patients with no thallium redistribution (confidence interval for the risk difference: 0.624, 0.256). The results also suggested that clinical factors might allow identification of a low-risk subset of patients. To test the hypothesis that patients with no evidence of congestive heart failure, angina, prior myocardial infarction, or diabetes do not require further preoperative testing, we evaluated an additional 50 patients having vascular procedures. None of the 23 without the clinical markers had untoward outcomes, while ten of 27 patients with one or more of these clinical markers suffered postoperative ischemic events (confidence interval for the risk difference: 0.592,0.148). In the clinical high-risk subset, further risk stratification is achieved with dipyridamolethallium scanning.

(JAMA 1987;257:2185-2189)

Author Affiliations
From the Departments of Medicine (Drs Eagle, Singer, Mulley, and Boucher) and Surgery (Drs Brewster and Darling), Massachusetts General Hospital, Boston.

Footnotes
Reprint requests to Cardiac Unit and Medical Practices Evaluation Unit, Massachusetts General Hospital, Fruit Street, Boston, MA 02114 (Dr Eagle).

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