Exercise equilibrium radionuclide angiography predicts long-term cardiac prognosis in patients with abdominal aortic aneurysm being considered for surgery

Background, Patients with an abdominal aortic aneurysm (AAA) have a high pr evalence of coronary disease and are at risk for cardiac events, This may o ffset the prognostic benefit of surgical repair. We investigated whether pr eoperative exercise equilibrium radionuclide angiography (ERNA) could be us ed to identify patients at high risk for cardiac events after successful AA A repair. Methods, Between 1990 and 1995, 173 patients with an AAA were referred for supine bicycle exercise ERNA preoperatively, Follow-up information was obta ined from a questionnaire sent to each patient's family physician. Cardiac events were defined as cardiac death or nonfatal myocardial infarction, Results, A total of 139 patients were able to exercise and did not die or s uffer myocardial infarction perioperatively, The median follow-up period wa s 3.8 years. Diabetes mellitus, an exercise ejection fraction (EF) below 0. 50, and a fall in EF with exercise were univariable predictors of cardiac r isk during the follow-up period (P < .05), On multivariable analysis, diabe tes mellitus (risk ratio [RR], 6.9; 95% CI 1.5 to 32.0) and an EF fall (RR, 4.1; 95% CI 1.5 to 11.4) emerged as the most important predictors. Conclusions. Exercise ERNA predicts long-term cardiac events in patients be ing considered for elective AAA repair. Such predictive information may inf luence the decision to operate, for example, on small unthreatening aneurys ms, or lead to invasive cardiological management to minimize risk.