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Angina and persistent exercise thallium defects: independent risk factors in elective vascular surgery
E O McFalls1, K M Doliszny, F Grund
1Department of Cardiology, Veterans Affairs Hospital, Minneapolis, Minnesota 55417.
Insights
Angina and fixed thallium defects after exercise independently predict cardiac complications in vascular surgery patients. These findings aid in assessing cardiac risk before surgery.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Vascular Surgery
Background:
- Patients undergoing elective vascular surgery face a high risk of perioperative cardiac complications.
- Assessing this risk is crucial for patient management and outcomes.
Purpose of the Study:
- To evaluate the predictive value of exercise thallium-201 scintigraphy and clinical factors for perioperative cardiac complications.
- To identify independent predictors of cardiac events in patients undergoing elective vascular surgery.
Main Methods:
- A cohort of 116 male patients (mean age 67) undergoing elective vascular surgery was studied.
- Clinical history, electrocardiogram, exercise thallium-201 scintigraphy, and rest ejection fraction were assessed.
- Logistic regression analysis was used to determine independent predictors of complications.
Main Results:
- 22 patients (18.9%) experienced perioperative myocardial infarctions, with 2 cardiac deaths (1.7%).
- History of coronary artery disease, angina, prior myocardial infarction, abnormal ECG, and abnormal exercise thallium tests were more frequent in patients with complications.
- Independent predictors identified were angina and fixed thallium defects on exercise scintigraphy.
Conclusions:
- Angina and fixed thallium defects after exercise are significant independent predictors of cardiac risk in elective vascular surgery.
- These findings highlight the importance of nonredistribution on thallium scans in risk stratification.
Objectives:
In this study, we assessed the utility of exercise thallium-201 scintigraphy and other clinical factors in predicting perioperative cardiac complications in patients undergoing elective vascular surgery.
Background:
The risk of cardiac complications among such patients is very high.
Methods:
The study group comprised 116 men (mean age 67 years). Fifty patients (43%) had a history of coronary artery disease, including angina pectoris in 26 (22%), myocardial infarction in 32 (28%) and coronary artery bypass surgery in 19 (16%).
Results:
There were a total of 22 perioperative myocardial infarctions (18.9%), including 2 cardiac deaths (1.7%). A significantly greater proportion (p < 0.05) of patients with than without perioperative complications had a history of coronary artery disease (77% vs. 35%), angina (59% vs. 14%), prior myocardial infarction (50% vs. 22%), abnormal electrocardiogram (68% vs. 40%) and abnormal exercise thallium test (75% vs. 47%). The patient group with complications also had a significantly lower mean rest ejection fraction (45 +/- 3% vs. 55 +/- 2%, p < 0.005). Independent predictors of complication, as determined by straight logistic regression, were angina and fixed thallium defects after exercise.
Conclusions:
Our data indicate that angina and the presence of fixed thallium defects after exercise are independent predictors of cardiac risk in patients undergoing elective vascular surgery. These findings are compatible with other studies showing that nonredistribution on standard 3- to 4-h delayed studies cannot exclude viable myocardium at risk.