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Abstract

Stress myocardial perfusion testing may be used in the preoperative evaluation and cardiac risk stratification of patients undergoing aortofemoral bypass. The study aims to evaluate the value of a negative stress radionuclide myocardial perfusion test for prediction of cardiac events (myocardial infarction, sudden cardiac death, unstable angina, coronary artery revascularization, and congestive heart failure) in patients undergoing aortofemoral bypass.

We studied 25 subjects (13 men, 12 women, average age 62) with radiographically proven, significant aortofemoral occlusive disease, who had multiple coronary artery disease risk factors (hypertension, diabetes, tobacco abuse, elevated cholesterol, and positive family history: average 1.8 coronary artery disease risk factors) but a negative preoperative stress myocardial perfusion study for myocardial ischemia (no transient or partially reversible myocardial perfusion defect). Of these 25 patients, 3 patients were able to exercise and achieve their adequate 85% maximum predicted heart rate. Seventeen patients received adenosine infusion of 140 mg/kg/min for 6 minutes, 4 patients received dipyridamole infusion of .56 mg/kg over 4 minutes, and 1 patient received dobutamine infusion at 5, 10, 20, 30, and 40 mg/kg/minute. Of the 25 patients, 22 received 3 to 4 mCi of thallium-201 and 3 patients received 8 to 9 mCi of technetium-99m sestamibi at rest and 25 to 30 mCi technetium-99m sestamibi during stress. The subjects all had aortofemoral bypass and were followed up to one year for any cardiac events.

One patient had coronary artery bypass grafting 11 months after aortofemoral bypass. One died from a stroke one month following aortofemoral bypass surgery. Of the remaining 23 patients, none had any cardiac events up to one year after aortic femoral bypass surgery.

The absence of ischemia on exercise or pharmacological stress radionuclide myocardial perfusion study correctly identified patients that had low cardiac events up to one year following aortofemoral bypass surgery.

Aortofemoral Bypass, Myocardial Perfusion, Stress Testing
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© American Journal of Hypertension, Ltd. 2001
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