Preoperative Cardiac Evaluation by Dipyridamole Thallium-201 Myocardial Perfusion Scan Provides no Benefit in Patients with Abdominal Aortic Aneurysm

The purpose of the present study was to evaluate the benefits of a preoperative dipyridamole thallium-201 myocardial perfusion scan in patients undergoing abdominal aortic aneurysm (AAA) repair.

We retrospectively reviewed findings in a prospectively collected database of patients undergoing open or endovascular repair of AAA at the Asan Medical Center, Seoul, Korea, from January 2001 to May 2011.

Of 373 patients, 11 (2.9 %) had postoperative myocardial infarction (MI), whereas 24 (6.4 %), 17 (4.6 %), 24 (6.4 %), and 8 (2.1 %) were diagnosed with myocardial ischemia, atrial fibrillation, ventricular arrhythmia, and congestive heart failure, respectively. The incidence of 30-day cardiac-related mortality was 1.6 % (6 of 373 patients). The preoperative variables significantly associated with postoperative cardiac events in multivariate analysis were preoperative congestive heart failure (odds ratio [OR] 8.8, 95 % confidence interval [CI] 1.36–56.73, p = 0.022), long-acting nitrates (OR 8.1, 95 % CI 1.22–54.26, p = 0.03), and body mass index (BMI) higher than 26 (OR 3.6, 95 % CI 1.49–8.48, p = 0.004). The variables obtained from dipyridamole thallium-201 myocardial perfusion scan were not correlates of postoperative cardiac events. The sensitivity of reversible defects for postoperative cardiac events was 14 % and the specificity was 90 %. Subgroup analyses revealed that thallium defects were not significant variables in predicting postoperative cardiac events in patients with coronary artery disease (CAD) or in no-CAD patients.

Preoperative dipyridamole thallium-201 myocardial perfusion scans were ineffective in predicting postoperative cardiac complications in AAA patients. These results suggest that the routine use of these tests for preoperative screening of patients undergoing AAA repair may not be warranted.