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Title

Valeur pronostique de la tomoscintigraphie myocardique au thallium-201 sensibilisée au dipyridamole avant chirurgie artérielle periphérique

Authors
Vaquette, B
Dorsaz, P A
Published in Archives des maladies du coeur et des vaisseaux - Pratique. 2003, vol. 96, no. 4, p. 281-7
Abstract The evaluation of patients who are candidates for peripheral arterial surgery is difficult. The aim of this study was to show that dipyridamole stress scintigraphy could be a prognostic aid for patient selection. Between 1991 and 2000, 275 patients underwent dipyridamole stress myocardial scintigraphy before peripheral arterial surgery of the lower limbs (49%), the aortic (33%) or carotid arteries (18%). A perfusion defect was observed in 145 patients suggesting myocardial ischaemia in 79 cases and myocardial infarction in 66 cases. Twenty-seven of the 79 ischaemic patients underwent a preoperative coronary revascularisation. The operative adverse coronary events (5%) were: 7 non-fatal myocardial infarctions and 7 acute coronary syndromes. The 79 ischaemic patients had a higher risk of adverse coronary events: 11% (ischaemia) versus 3% (no ischaemia) (p < 0.01). Myocardial scintigraphy allowed stratification of patients with an intermediate risk of Eagle's score into high coronary risk (15%, ischaemia) or low coronary risk (2%, no ischaemia) (p < 0.01). The extent of the ischaemia was associated with a higher risk of adverse coronary events: 4 zones (20%) versus 1 zone (5%) (p = 0.02). Preoperative coronary revascularisation tended to reduce the risk of adverse coronary events from 15% to 4% (p = NS). Myocardial ischaemia (p < 0.0001) and left bundle branch block (p = 0.002) were the two predictive factors of an adverse operative coronary event. Thallium-dipyridamole myocardial scintigraphy with a high negative predictive value (97%) is a useful tool for the identification of high risk patients for whom an aggressive preoperative therapeutic strategy may be beneficial.
Keywords AgedDipyridamole/diagnostic useFemaleHeart/radionuclide imagingHumansMaleMyocardial Infarction/radionuclide imaging/surgeryMyocardial Ischemia/radionuclide imaging/surgeryMyocardial Revascularization/adverse effectsPredictive Value of TestsPrognosisRetrospective StudiesThallium Radioisotopes/diagnostic useVascular Surgical Procedures/adverse effectsVasodilator Agents/diagnostic use
Identifiers
PMID: 12741302
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Article (Published version) (894 Kb) - document accessible for UNIGE members only Limited access to UNIGE
Structures
Research group Chirurgie cardio-vasculaire (105)
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(ISO format)
VAQUETTE, B et al. Valeur pronostique de la tomoscintigraphie myocardique au thallium-201 sensibilisée au dipyridamole avant chirurgie artérielle periphérique. In: Archives des maladies du coeur et des vaisseaux - Pratique, 2003, vol. 96, n° 4, p. 281-7. https://archive-ouverte.unige.ch/unige:45737

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Deposited on : 2015-01-22

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