Key result
Preoperative MPI is linked to ~67% fewer 30-day cardiac events in high-risk non-cardiac surgery patients.
Why the study?
The role of myocardial perfusion imaging stress tests using sCMR and SPECT-MPI in preoperative management before non-cardiac surgery required investigation.
Does a preoperative myocardial perfusion imaging stress test strategy reduce 30-day postoperative cardiac events in patients with CAD or multiple risk factors undergoing intermediate-to-high-risk non-cardiac surgery?
Cohort (n=1,590)
No
Does a preoperative myocardial perfusion imaging stress test strategy reduce 30-day postoperative cardiac events in patients with CAD or multiple risk factors undergoing intermediate-to-high-risk non-cardiac surgery?
Effect estimate: OR 0.33 (95% CI 0.15-0.76)
Absolute Event Rate: 1.2% vs 3.4%
p-value: p=0.009
A preoperative stress imaging strategy (sCMR or SPECT-MPI) is associated with a significantly lower risk of 30-day cardiac complications in high-risk patients undergoing intermediate-to-high-risk non-cardiac surgery.
May support preoperative stress testing in high-risk patients; leaves open confirmation by randomized trials.
PURPOSE: The objective of this study was to investigate the role of myocardial perfusion imaging (MPI) stress tests using stress cardiac magnetic resonance (sCMR) and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in non-cardiac surgery (NCS) pre-operatory management. MATERIALS AND METHODS: This monocentric retrospective study enrolled patients with coronary artery disease or a minimum of two cardiovascular risk factors undergoing intermediate-to-high-risk non-cardiac surgeries. The primary composite endpoint comprised cardiac death, cardiogenic shock, acute coronary syndromes (ACS), and cardiogenic pulmonary edema occurring within 30 days after surgery, while the secondary endpoint was ACS. RESULTS: A total of 1590 patients were enrolled; among them, 669 underwent a MPI stress test strategy (sCMR: 287, SPECT-MPI: 382). The incidence of 30-day cardiac events was lower in the stress-tested group compared to the non-stress-tested group (1.2% vs. 3.4%; p 0.006). Adopting a stress test strategy showed a significant reduction in the risk of the composite endpoint (OR: 0.33, 95% CI: 0.15-0.76, p 0.009) and ACS (OR: 0.41, 95% CI: 0.17-0.98, p 0.046) at multivariable analysis, with similar cardiac events rate between stress CMR and SPECT (1.1% vs. 1.3%, p 0.756). Stress CMR showed a greater accuracy to predict coronary artery revascularizations (sCMR c-statistic: 0.95, ischemic cut-point: 5.5%; SPECT c-statistic: 0.85, ischemic cut-point: 7.5%). CONCLUSION: Stress test strategy is related to a lower occurrence of cardiac events in high-risk patients scheduled for intermediate-to-high-risk non-cardiac surgeries. Both sCMR and SPECT-MPI comparably reduce the likelihood of cardiac complications, albeit sCMR offers greater accuracy in predicting coronary artery revascularization.
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Fazzari et al. (2024) conducted a cohort in Intermediate-to-high-risk non-cardiac surgery in patients with coronary artery disease or ≥2 cardiovascular risk factors (n=1,590). Myocardial perfusion imaging (MPI) stress test (sCMR or SPECT-MPI) vs. No stress test was evaluated on Composite of cardiac death, cardiogenic shock, acute coronary syndromes, and cardiogenic pulmonary edema at 30 days (OR 0.33, 95% CI 0.15-0.76, p=0.009). A preoperative myocardial perfusion imaging stress test strategy significantly reduced the risk of 30-day composite cardiac events (OR 0.33) compared to no stress testing in high-risk patients undergoing non-cardiac surgery.
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