Eagle K A, Singer D E, Brewster D C, Darling R C, Mulley A G, Boucher C A
JAMA. 1987 Apr 24;257(16):2185-9.
Dipyridamole-thallium imaging has been suggested as a method of preoperatively assessing cardiac risk in patients undergoing major surgery. To define more clearly its proper role in preoperative assessment, we prospectively evaluated 111 patients undergoing vascular surgery. In the first set of 61 patients, our data confirmed the value of preoperative dipyridamole-thallium scanning in identifying the patients who suffered postoperative ischemic events. Events occurred in eight of 18 patients with reversible defects on preoperative imaging, compared with no events in 43 patients with no thallium redistribution (confidence interval for the risk difference: 0.624, 0.256). The results also suggested that clinical factors might allow identification of a low-risk subset of patients. To test the hypothesis that patients with no evidence of congestive heart failure, angina, prior myocardial infarction, or diabetes do not require further preoperative testing, we evaluated an additional 50 patients having vascular procedures. None of the 23 without the clinical markers had untoward outcomes, while ten of 27 patients with one or more of these clinical markers suffered postoperative ischemic events (confidence interval for the risk difference: 0.592, 0.148). In the clinical high-risk subset, further risk stratification is achieved with dipyridamole-thallium scanning.
双嘧达莫-铊心肌显像已被提议作为一种对接受大手术患者进行术前心脏风险评估的方法。为了更清楚地界定其在术前评估中的恰当作用，我们对111例接受血管手术的患者进行了前瞻性评估。在第一组61例患者中，我们的数据证实了术前双嘧达莫-铊心肌扫描在识别术后发生缺血事件患者方面的价值。术前显像有可逆性缺损的18例患者中有8例发生了事件，而43例无铊再分布的患者未发生事件（风险差异的置信区间：0.624，0.256）。结果还表明临床因素可能有助于识别低风险患者亚组。为了检验无充血性心力衰竭、心绞痛、既往心肌梗死或糖尿病证据的患者无需进一步术前检查这一假设，我们对另外50例接受血管手术的患者进行了评估。23例无这些临床指标的患者均未出现不良后果，而27例有一项或多项这些临床指标的患者中有10例发生了术后缺血事件（风险差异的置信区间：0.592，0.148）。在临床高风险亚组中，通过双嘧达莫-铊心肌扫描可进一步进行风险分层。
