European journal of nuclear medicine and molecular imaging · 2025
Risk stratification with pre-operative myocardial perfusion imaging.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kim Dayoung, Builoff Valerie, Sharir Tali, Hauser M Timothy, Dorbala Sharmila, Di Carli Marcelo F, Fish Mathews B, Ruddy Terrence D, Bateman Timothy M, Einstein Andrew J, Kaufmann Philipp A, Miller Edward J, Sinusas Albert J, Acampa Wanda, Halcox Julian, Dey Damini, Berman Daniel S, Miller Robert J H, Slomka Piotr J
Аннотация
PURPOSE: Myocardial perfusion imaging (MPI) is frequently used to improve cardiac risk prediction in patients undergoing non-cardiac surgery. However, the data supporting this practice is derived from single center studies and predates current therapy for coronary artery disease (CAD). We evaluated the association between pre-operative testing indication and outcomes as well as predictors of death or myocardial infarction (MI) in these patients.
METHODS: We include patients from the international, multicenter REFINE-SPECT registry (13 sites). Based on referral indication, patients were classified as pre-operative testing indications and non-pre-operative testing. We evaluated the associations between pre-operative testing and incidence of death or MI. We then evaluated associations with death or MI in patients referred for pre-operative testing compared to other patients.
RESULTS: In total, 32,711 patients were included with pre-operative testing as the indication in 2,173(6.6%) patients. Patients referred for pre-operative testing were more likely to experience death or MI (annualized rate 4.4% vs 1.6%, p < 0.001). In patients referred for pre-operative testing, stress, rest, and ischemic total perfusion deficit were associated with death or MI. Rest total perfusion deficit (adjusted hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.07 - 1.45) was independently associated with death or MI, but pharmacologic stress testing was not (adjusted HR 0.88, 95% CI 0.70 - 1.12).
CONCLUSION: Patients undergoing pre-operative SPECT MPI are at increased cardiovascular risk which may reflect selection bias or unmeasured confounders. Resting perfusion abnormalities may identify patients at higher risk, potentially helping guide peri-operative care.
METHODS: We include patients from the international, multicenter REFINE-SPECT registry (13 sites). Based on referral indication, patients were classified as pre-operative testing indications and non-pre-operative testing. We evaluated the associations between pre-operative testing and incidence of death or MI. We then evaluated associations with death or MI in patients referred for pre-operative testing compared to other patients.
RESULTS: In total, 32,711 patients were included with pre-operative testing as the indication in 2,173(6.6%) patients. Patients referred for pre-operative testing were more likely to experience death or MI (annualized rate 4.4% vs 1.6%, p < 0.001). In patients referred for pre-operative testing, stress, rest, and ischemic total perfusion deficit were associated with death or MI. Rest total perfusion deficit (adjusted hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.07 - 1.45) was independently associated with death or MI, but pharmacologic stress testing was not (adjusted HR 0.88, 95% CI 0.70 - 1.12).
CONCLUSION: Patients undergoing pre-operative SPECT MPI are at increased cardiovascular risk which may reflect selection bias or unmeasured confounders. Resting perfusion abnormalities may identify patients at higher risk, potentially helping guide peri-operative care.