Limited Utility of Dipyridamole-Thallium for Predicting Adverse Cardiac Events After Vascular Surgery

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Abstract
The objective of this retrospective study was to determine the value of dipyridamolethallium (PTHAL) and Eagle criteria (Q wave on ECG, ventricular ectopy, diabetes, congestive heart failure, age >70, angina) in predicting cardiac events after vascular surgery at a Veteran Affairs hospital. The main outcome measures were adverse cardiac events. Of 211 vascular procedures, 148 were performed without, and 63 performed with, preoperative PTHAL. Thirty-six patients had redistribution on PTHAL, but only two underwent preoperative coronary revascularization. There were 10 cardiac events (4.8%), five in each group (p=NS). Cardiac events were increased with?one Eagle criteria (6.7% vs 0% with no Eagle, p=0.04), but not with PTHAL redistribution. Conclusions: Prior to elective vascular surgery: (1) PTHAL redistribution did not predict cardiac events. (2) Cardiac morbidity was increased with >one Eagle criteria. (3) Cardiac testing is not indicated in patients without Eagle criteria.