Role of dipyridamole myocardial scintigraphy in abdominal aortic aneurysm repair

Background. We evaluated the usefulness of preoperative dipyridamole myocardial scintigraphy (DMS) under low-level exercise in predicting postoperative cardiac problems in patients undergoing elective abdominal aortic aneurysm (AAA) repair. Methods. Experimental design: retrospective comparison of patients who did and did not undergo the investigation preoperatively. Setting: at the Keio University Hospital and the Kawasaki City Hospital. Patients: eighty-five patients who had abdominal aortic aneurysm repair consecutively from 1986 to 1990 without undergoing dipyridamole myocardial scintigraphy preoperatively were compared with 118 patients who underwent the repair consecutively from 1991 to 1997 after having had preoperative scintigraphy. Measurements: postoperative occurrences of myocardial infarction and angina pectoris in the two groups of patients were compared statistically. Results. In the group not having scintigraphy, cardiac events occurred in 12 patients (14.1%) after repair. Ten patients had a myocardial infarction; six died within 30 days of operation and four died after the 31st postoperative day. The other two patients had angina pectoris; both survived. In the group having scintigraphy, there were no postoperative cardiac events (p < 0.0001). Seventeen patients had positive results on preoperative scintigraphy. Seven of them had undergone coronary artery bypass grafting and five coronary angioplasty before the repair. In the five other patients, scintigraphy, was found to have yielded false positive results. Conclusions. Dypiridamole myocardial scintigraphy is an accurate predictor of postoperative myocardial infarction and angina pectoris in patients being evaluated for elective abdominal aortic aneurysm repair and should be used routinely.