VOLUME 37 | ISSUE 6 | NOVEMBER-DECEMBER 2017

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Prevalence and predictors of myocardial ischemia by preoperative myocardial perfusion single photon emission computed tomography in patients undergoing noncardiac surgery

Abdelkareem Saleh Al-Oweidi,a,b Hesham Albabtain,b Suleiman M. Kharabsheh,c Peter Kimme,b Mahmoud Almustafa,b Samer Seder,b Mohamed Shoukri,d Ahmed L. Fathalae 

From the aDepartment of Anesthesia, University of Jordan, Amman, Jordan, bDepartment of Anesthesiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; cDepartment of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; dDepartment of cell Biology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; eDepartment of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia 

How to cite this article:

Al-Oweidi AS, Albabtain H, Kharabsheh SM, Kimme P, Almustafa M, Seder S, et al. Prevalence and predictors of myocardial ischemia by preoperative myocardial perfusion single photon emission computedtomography in patients undergoing noncardiac surgery. Ann Saudi Med 2017; 37(6): 461-468.

DOI: 10.5144/0256-4947.2017.461

Abstract

BACKGROUND: The prevalence and predictors of myocardial ischemia before noncardiac surgery are unknown. In addition the predictive value of myocardial perfusion single-photon emission computed tomography (SPECT) before noncardiac in individual patients is uncertain.

 

OBJECTIVE: Evaluate the prevalence and predictors of myocardial ischemia before noncardiac surgery, and determine the postoperative cardiac outcome based on results of myocardial perfusion SPECT. 

 

DESIGN: Retrospective.

 

SETTING: Single tertiary care center.

 

PATIENTS AND METHODS: We reviewed the records of adult patients diagnosed with myocardial ischemia by myocardial perfusion SPECT who were undergoing noncardiac surgery. Myocardial perfusion SPECT had been performed within 4 weeks prior to noncardiac surgery requiring general anesthesia.

 

MAIN OUTCOME MEASURES: Prevalence of abnormal myocardial perfusion SPECT results on preoperative evaluation; abnormal myocardial perfusion SPECT results as a predictor for postoperative cardiac events such as cardiac death, nonfatal myocardial infarction, and unstable angina. 

 

RESULTS: Of 131 patients who underwent noncardiac surgery from February 2015 to April 2016, 84 (64%) patients were female and the mean (SD) age was 64.1 (13.6) years. The prevalence of abnormal myocardial perfusion SPECT was 18% (24 of 131). Normal myocardial perfusion SPECT was highly predictive (up to 100%), but a positive myocardial perfusion SPECT had low positive predictive value (4%). Variables associated with an abnormal myocardial perfusion SPECT included ischemic heart disease, congestive heart failure, ASA score of 3 or more, limited exercise capacity (less than 4 METs), male sex, hypercholesterolemia, hypertension, smoking, and abnormal ECG. In a multivariable analysis, history of ischemic heart disease and history of smoking were significant predictors of abnormal myocardial perfusion SPECT (P=.001, and .029, respectively).

 

CONCLUSIONS: Because of the low positive predictive value of myocardial perfusion SPECT, utilization of the technique in the workup of cardiac patients undergoing noncardiac surgery has been inappropriate. Myocardial perfusion SPECT should be restricted to only clearly defined appropriate use criteria. 

 

LIMITATIONS: Relatively small number of patients and retrospective design. 

 

 

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