A COMPARISON OF DIPYRIDAMOLE-THALLIUM-201 SCINTIGRAPHY AND CLINICAL EXAMINATION IN THE DETERMINATION OF CARDIAC RISK BEFORE ARTERIAL RECONSTRUCTION

Preoperative clinical examination, including a 12-lead resting ECG, an d planar dipyridamole thallium imaging (DTI) were compared in a prospe ctive study of 65 vascular surgical patients in regard to their value for predicting postoperative cardiac complications. Fifty-three patien ts underwent abdominal vascular procedures and 12 were operated ori fo r peripheral artery disease. Thirty-six patients had ischemic heart di sease (IHD) and/or abnormal findings from 12-lead resting ECG. Of thes e 36 patients, 11 had nonfatal cardiac complications. The remaining 29 patients were free of IHD and had normal results from ECG. No complic ations occurred among these 29 patients. There was no postoperative de ath. Thallium imaging results were abnormal in 45 patients, showing ei ther redistribution and/or scar tissue or low washout. In 18 of these patients major changes with redistribution were present in all project ions. Among these patients, 9 had a nonfatal cardiac complication. In the 27 patients with abnormalities in only one or two projections, onl y 2 had a cardiac event postoperatively. No cardiac complications occu rred in patients with normal thallium scintigraphy findings. The patie nts were operated on irrespective of the results of the scans, and all recovered from any cardiac complications that occurred. In vascular s urgical patients with previous IHD and/or abnormal findings from resti ng ECGs further risk stratification is achieved with DTI.