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Purpose <p>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.</p> Methods <p>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.</p> Results <p>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%, <i>p</i> &lt; 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).</p> Conclusion <p>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.</p>

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Risk stratification with pre-operative myocardial perfusion imaging

  • 期刊论文

  • 发表日期：

    2025年10月27日

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  • Dayoung Kim,
  • Valerie Builoff,
  • Tali Sharir,
  • M. Timothy Hauser,
  • Sharmila Dorbala,
  • Marcelo F. Di Carli,
  • Mathews B. Fish,
  • Terrence D. Ruddy,
  • Timothy M. Bateman,
  • Andrew J. Einstein,
  • Philipp A. Kaufmann,
  • Edward J. Miller,
  • Albert J. Sinusas,
  • Wanda Acampa,
  • Julian Halcox,
  • Damini Dey,
  • Daniel S. Berman,
  • Robert J. H. Miller,
  • Piotr J. Slomka

摘要

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.