Preoperative risk evaluation in diabetic patients without angina

Aims: The aim of the current study was to clarify whether stress myocardial perfusion single-photon emission computed tomography (SPECT) stratifies perioperative cardiac risk in noncardiac surgery of diabetic patients without chest pain. Methods: This study enrolled consecutive 284 patients with diabetes mellitus (DM) without chest pain who underwent noncardiac surgery after dipyridamole stress SPECT. Myocardial perfusion and cardiac function were simultaneously evaluated in the SPECT examination. We sought clinical and imaging variables predictive of perioperative cardiac events, and estimated the prognostic value of SPECT. Results: No clinical risk factors were proved to be significant predictors of perioperative cardiac events except the duration of diabetes. In contrast, myocardial perfusion imaging itself and the combination of information on perfusion and cardiac function provided significant risk stratification. The event rate in patients with normal perfusion was low regardless of surgical procedures, while that in patients with abnormal perfusion increased depending on the operation risk. Conclusions: Normal myocardial SPECT findings ensure the low likelihood of perioperative cardiac events in DM patients without chest pain. Perfusion and/or functional abnormalities are associated with the adverse outcome especially in high-risk operation.