Myocardial perfusion imaging failed to improve patient risk classification compared with the revised cardiac risk index for early cardiac complications after major non‐cardiac surgery

Abstract

Background Myocardial perfusion imaging (MPI) is frequently used for cardiac risk assessment before major non‐cardiac surgery, but its ability to improve patient risk classification beyond simple clinical assessment is unknown. Aim To explore the prognostic utility of MPI above a simple clinical risk calculator, the revised cardiac risk index (RCRI). Methods A retrospective cohort study of at‐risk patients who underwent MPI before major non‐cardiac surgery in a tertiary hospital was conducted. Major adverse cardiac events (MACE) was defined as any myocardial infarction, acute pulmonary oedema, ventricular arrhythmia or cardiac death within 30 days of surgery. We analysed the predictive value of MPI for MACE using multivariable logistic regression and categorical net reclassification index. Results MACE occurred in 47 (7.4%) cases from 635 surgical procedures in 629 patients. MPI‐identified medium or large‐sized reversible perfusion defects (P = 0.02; odds ratio 2.9; 95% confidence interval 1.1–7.1) and RCRI score two or more (P = 0.03; odds ratio 2.3; 95% confidence interval 1.1–4.8) were significantly associated with MACE after adjusting for age, coronary revascularisation, surgical priority, need for general anaesthesia, left ventricular ejection fraction (LVEF) and fixed perfusion defects. MPI risk factors (LVEF, reversible perfusion and fixed perfusion defects) did not improve risk classification above baseline risk factors (age, RCRI and surgical priority). Conclusion MPI risk factors are weak predictors for early cardiac complications after major non‐cardiac surgery and failed to improve patient risk classification beyond essential assessment using age, RCRI and surgical priority. Clinicians should consider alternative risk assessment strategies because of MPI's poor prognostic utility and its associated time and financial costs.

Association Between Preoperative Myocardial Perfusion Imaging and Cardiac Events after Elective Noncardiac Surgery

“…23 However, other studies have shown that routine use of MPI before abdominal aortic surgery did not predict the risk of cardiac complications 26,27 and did not improve patient risk classification beyond essential assessment using age, RCRI, and surgical priority. 28 However, These previous studies were limited by relatively small sample sizes and low event rates, inclusion of mainly patients undergoing relatively high-risk vascular surgery, and the use of outdated perfusion imaging techniques and perioperative management. 15,29 In contrast, our study included the largest population to date and included a broad spectrum of patients and surgical procedures across the full risk spectrum, thus demonstrating the consistent prognostic utility of MPI for predicting perioperative cardiac risk in contemporary practice.…”

Association between Cardiovascular Risk Factors and High-risk Features in Myocardial Perfusion Imaging: A Multicenter Study

“…The total score was the difference between the stress and rest scores and was considered an index of ischemic burden. 10 , 11 For the differentiation between ischemia and diaphragmatic attenuation, in patients with ischemia in the inferior wall, MPI was repeated in the prone position. A diagnosis of ischemia was confirmed when the defect remained constant.…”

Assessment and Correction of the Cardiac Complications Risk in Non-cardiac Operations – What's New?

“…При этом риск операции по шкале VSG-CRI не отличался между центрами с высоким и низким уровнем стресс-тестирования [50]. Также при оценке нарушений перфузии миокарда отмечено, что ее результаты не смогли улучшить классификацию риска для пациентов перед большими некардиальными операциями при сравнении с данными, основанными на использовании возраста, RCRI и хирургической приоритетности [51]. Возможно, что значение рутинных стресс-тестов перед проведением сосудистых операций следует пересмотреть, а стресстесты следует использовать более избирательно, в том числе, учитывая затраты на широкомасштабное тестирование.…”