MYOCARDIAL PERFUSION SCINTIGRAPHY IN PATIENTS UNDERGOING MAJOR NONVASCULAR ABDOMINAL-SURGERY

The prognostic value of myocardial perfusion scintigraphy is beginning to be recognised in patients undergoing cardiovascular surgery. The a im of this prospective study was to assess the predictive value of sci ntigraphy in elderly patients undergoing major non-vascular abdominal surgery. thallium-201 (Tl-201) single-photon emission tomography (SPET ) was employed for imaging using a standard protocol. Patients over th e age of 60 years (n=55) with an intermediate to high likelihood of co ronary artery disease were evaluated prospectively. The clinical outco me variables analysed were cardiac mortality and major cardiac morbidi ty occurring within 30 days of surgery. Cardiac events were cardiac de ath (n=5), angina pectoris (n=5), nonfatal mycardial infarction (n=1), acute left ventricular failure (n=2) and arrhythmias requiring treatm ent (n=4). All cardiac events occurred in the first 10 postoperative d ays except one cardiac death which happened on the 29th postoperative day. Patients with an abnormal Tl-201 SPET scan had a higher risk of p ostoperative death (4 vs I) or any postoperative cardiac event (13 pat ients vs 4 patients; P<0.0001) when compared with those with a normal scan. The sensitivity, specificity and positive predictive value of Tl -201 imaging for perioperative ischaemia and adverse outcomes were 76% , 82% and 65%, respectively. The occurrence of an intraoperative event (P<0.02) and the length of surgery (P<0.01) were also predictors of a postoperative cardiac event. Clinical risk variables and an abnormal electrocardiogram in isolation were poor predictors. In conclusion, pr eoperative myocardial perfusion scintigraphy is a valuable technique f or identifying elderly patients with a high risk for cardiac events wh en undergoing major non-vascular abdominal surgery.