DOES ROUTINE STRESS THALLIUM CARDIAC SCANNING REDUCE POSTOPERATIVE CARDIAC COMPLICATIONS

Objective Prophylactic cardiac revascularization in patients with isch emic myocardium could reduce postoperative cardiac complications after aortic reconstruction. However, the effectiveness of this approach ha s not been documented. Summary Background Data Stress-thallium scannin g can identify patients with ischemic myocardium. Morbidity and mortal ity after aortic reconstruction appears to be largely caused by co-exi stent coronary artery disease, and patients who have had recent cardia c revascularization have few postoperative cardiac complications. Meth ods Preoperative stress-thallium scanning was evaluated prospectively in 146 patients undergoing aortic reconstruction. Patients with positi ve studies underwent coronary arteriography and cardiac revascularizat ion, when appropriate. Postoperative cardiac complications and long-te rm survival in these patients were compared with results from 172 simi lar patients undergoing aortic reconstruction without stress-thallium scanning. Results also were analyzed to determine predictors of postop erative cardiac events. Results Forty-one per cent of patients undergo ing stress-thallium testing underwent coronary arteriography, and 11.6 % had cardiac revascularization. In contrast, 14.7% of patients treate d without stress-thallium testing had coronary arteriography, and 4.1% had revascularization (p < 0.01). Despite this, cardiac mortality, se rious cardiac complications, and long-term cardiac mortality were simi lar in both groups. Only advanced age and intraoperative complications (but not a positive stress-thallium test) predicted postoperative car diac events. Conclusions Preoperative stress-thallium testing confirme d a high incidence of significant coronary artery disease in patients undergoing aortic reconstruction, but prophylactic cardiac interventio n does not reduce operative or long-term mortality. Thus, the risk and expense or routine stress-thallium testing and subsequent cardiac rev ascularization cannot be justified.