ANGINA AND PERSISTENT EXERCISE THALLIUM DEFECTS - INDEPENDENT RISK-FACTORS IN ELECTIVE VASCULAR-SURGERY

Objectives. In this study, we assessed the utility of exercise thalliu m-201 scintigraphy and other clinical factors in predicting perioperat ive cardiac complications in patients undergoing elective vascular sur gery. Background. The risk of cardiac complications among such patient s is very high. Methods. The study group comprised 116 men (mean age 6 7 years). Fifty patients (43%) had a history of coronary artery diseas e, including angina pectoris in 26 (22%), myocardial infarction in 32 (28%) and coronary artery bypass surgery in 19 (16%). Results. There w ere a total of 22 perioperative myocardial infarctions (18.9%), includ ing 2 cardiac deaths (1.7%). A significantly greater proportion (p < 0 .05) of patients with than without perioperative complications had a h istory 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 r est ejection fraction (45 +/- 3% vs. 55 +/- 2%, p < 0.005). Independen t predictors of complication, as determined by straight logistic regre ssion, were angina and fixed thallium defects after exercise. Conclusi ons. Our data indicate that angina and the presence of fixed thallium defects after exercise are independent predictors of cardiac risk in p atients undergoing elective vascular surgery. These findings are compa tible with other studies showing that nonredistribution on standard 3- to 4-h delayed studies cannot exclude viable myocardium at risk.