Preoperative risk stratification with myocardial perfusion imaging in intermediate and low-risk non-cardiac surgery
Preoperative risk stratification with myocardial perfusion imaging in intermediate and low-risk non-cardiac surgery
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DOI：
10.1253/circj.71.1395
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发表时间：
2007-09-01
影响因子：
3.3
通讯作者：
Kubo, Atsushi
中科院分区：
文献类型：
--
作者：
Hashimoto, Jun;Nakahara, Tadaki;Kubo, Atsushi
背景：高危手术围手术期心脏风险常通过心肌灌注单光子发射计算机断层扫描（SPECT）进行分层。然而，很少和没有数据是关于中间和低风险surgery，respectively. Methods和Results共1,220例连续患者进行心电图门控潘生丁负荷SPECT评估心肌灌注和心脏功能之前，中间或低风险的非心脏手术。确定围手术期心脏事件的预测变量，并估计结合预试验信息和SPECT的增量预后价值的有用性。所有心脏事件的频率取决于临床风险因素和外科手术类型。在对具有临床危险因素和手术风险的患者进行分类后，心肌灌注或心功能评估在中等风险手术中产生了显著的风险分层，但在低风险手术中没有。增加功能数据灌注变量提供了一个增量预后值的患者与一个中间的临床风险和预定的中间风险surgics.Conclusions整合信息的临床危险因素，手术类型，心肌灌注和心脏功能允许详细的术前风险分层。术前SPECT提供了一个增量的预后价值在中间，但不是在低风险手术。
Background Perioperative cardiac risk in high risk surgery is often stratified with myocardial perfusion single-photon emission computed tomography (SPECT). However, little and no data are available about intermediate and low-risk surgery, respectively.Methods and Results A total of 1,220 consecutive patients underwent electrocardiography-gated dipyridamole stress SPECT to evaluate myocardial perfusion and cardiac function before intermediate or low risk non-cardiac surgery. Variables predictive of perioperative cardiac events were determined and the usefulness of combining pretest information and the incremental prognostic value of SPECT was estimated. The frequency of all cardiac events depended on clinical risk factors and type of surgical procedures. After sorting the patients with clinical risk factors and surgical risk, assessment of myocardial perfusion or cardiac function yielded significant risk stratification in intermediate, but not in low-risk surgery. Adding functional data to perfusion variables offered an incremental prognostic value for patients with an intermediate clinical risk and scheduled intermediate risk surgery.Conclusions Integrating information about clinical risk factors, type of surgery, myocardial perfusion and cardiac function allows detailed preoperative risk stratification. Preoperative SPECT provides an incremental prognostic value in intermediate, but not in low-risk surgery.