Department of General Medicine, Calvary Mater Hospital, Newcastle, New South Wales, Australia.
Department of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia.
Intern Med J. 2022 Jul;52(7):1203-1214. doi: 10.1111/imj.15662. Epub 2022 Jun 13.
Myocardial perfusion imaging (MPI) is frequently used for cardiac risk assessment before major non-cardiac surgery, but its ability to improve patient risk classification beyond simple clinical assessment is unknown.
To explore the prognostic utility of MPI above a simple clinical risk calculator, the revised cardiac risk index (RCRI).
A retrospective cohort study of at-risk patients who underwent MPI before major non-cardiac surgery in a tertiary hospital was conducted. Major adverse cardiac events (MACE) was defined as any myocardial infarction, acute pulmonary oedema, ventricular arrhythmia or cardiac death within 30 days of surgery. We analysed the predictive value of MPI for MACE using multivariable logistic regression and categorical net reclassification index.
MACE occurred in 47 (7.4%) cases from 635 surgical procedures in 629 patients. MPI-identified medium or large-sized reversible perfusion defects (P = 0.02; odds ratio 2.9; 95% confidence interval 1.1-7.1) and RCRI score two or more (P = 0.03; odds ratio 2.3; 95% confidence interval 1.1-4.8) were significantly associated with MACE after adjusting for age, coronary revascularisation, surgical priority, need for general anaesthesia, left ventricular ejection fraction (LVEF) and fixed perfusion defects. MPI risk factors (LVEF, reversible perfusion and fixed perfusion defects) did not improve risk classification above baseline risk factors (age, RCRI and surgical priority).
MPI risk factors are weak predictors for early cardiac complications after major non-cardiac surgery and failed to improve patient risk classification beyond essential assessment using age, RCRI and surgical priority. Clinicians should consider alternative risk assessment strategies because of MPI's poor prognostic utility and its associated time and financial costs.
心肌灌注成像（MPI）常用于重大非心脏手术前的心脏风险评估，但它在简单临床评估之外提高患者风险分类的能力尚不清楚。
探索 MPI 在简单临床风险计算器（修订后的心脏风险指数 [RCRI]）之上的预后预测能力。
对一家三级医院进行的重大非心脏手术后接受 MPI 的高危患者进行回顾性队列研究。主要不良心脏事件（MACE）定义为手术 30 天内发生任何心肌梗死、急性肺水肿、室性心律失常或心脏性死亡。我们使用多变量逻辑回归和分类净重新分类指数分析 MPI 对 MACE 的预测价值。
629 例患者中的 635 例手术中有 47 例（7.4%）发生 MACE。MPI 确定的中等或大面积可逆灌注缺损（P=0.02；优势比 2.9；95%置信区间 1.1-7.1）和 RCRI 评分≥2（P=0.03；优势比 2.3；95%置信区间 1.1-4.8）在调整年龄、冠状动脉血运重建、手术优先级、需要全身麻醉、左心室射血分数（LVEF）和固定灌注缺损后与 MACE 显著相关。MPI 风险因素（LVEF、可逆灌注和固定灌注缺损）并不能改善基于基线风险因素（年龄、RCRI 和手术优先级）的风险分类。
MPI 风险因素是重大非心脏手术后早期心脏并发症的弱预测因素，未能在使用年龄、RCRI 和手术优先级进行基本评估之外改善患者的风险分类。由于 MPI 的预后预测能力较差及其相关的时间和经济成本，临床医生应考虑替代风险评估策略。
