Key result
Myocardial perfusion imaging-identified reversible perfusion defects were associated with 30-day MACE (OR 2.9; 95% CI 1.1-7.1) but failed to improve risk classification beyond baseline risk factors.
Why the study?
Myocardial perfusion imaging is frequently used for preoperative cardiac risk assessment before major non-cardiac surgery, but its ability to improve risk classification beyond clinical assessment like the RCRI is unknown.
Does myocardial perfusion imaging improve patient risk classification for early cardiac complications after major non-cardiac surgery compared to the revised cardiac risk index?
Cohort (n=629)
No
Does myocardial perfusion imaging improve patient risk classification for early cardiac complications after major non-cardiac surgery compared to the revised cardiac risk index?
Odds Ratio: 2.9 (95% CI 1.1–7.1)
p-value: p=0.02
Myocardial perfusion imaging does not improve preoperative cardiac risk classification beyond simple clinical assessment using the Revised Cardiac Risk Index, suggesting alternative risk assessment strategies should be considered.
BACKGROUND: Myocardial perfusion imaging (MPI) is frequently used for cardiac risk assessment before major non-cardiac surgery, but its ability to improve patient risk classification beyond simple clinical assessment is unknown. AIM: To explore the prognostic utility of MPI above a simple clinical risk calculator, the revised cardiac risk index (RCRI). METHODS: A retrospective cohort study of at-risk patients who underwent MPI before major non-cardiac surgery in a tertiary hospital was conducted. Major adverse cardiac events (MACE) was defined as any myocardial infarction, acute pulmonary oedema, ventricular arrhythmia or cardiac death within 30 days of surgery. We analysed the predictive value of MPI for MACE using multivariable logistic regression and categorical net reclassification index. RESULTS: MACE occurred in 47 (7.4%) cases from 635 surgical procedures in 629 patients. MPI-identified medium or large-sized reversible perfusion defects (P = 0.02; odds ratio 2.9; 95% confidence interval 1.1-7.1) and RCRI score two or more (P = 0.03; odds ratio 2.3; 95% confidence interval 1.1-4.8) were significantly associated with MACE after adjusting for age, coronary revascularisation, surgical priority, need for general anaesthesia, left ventricular ejection fraction (LVEF) and fixed perfusion defects. MPI risk factors (LVEF, reversible perfusion and fixed perfusion defects) did not improve risk classification above baseline risk factors (age, RCRI and surgical priority). CONCLUSION: MPI risk factors are weak predictors for early cardiac complications after major non-cardiac surgery and failed to improve patient risk classification beyond essential assessment using age, RCRI and surgical priority. Clinicians should consider alternative risk assessment strategies because of MPI's poor prognostic utility and its associated time and financial costs.
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Yao et al. (2021) conducted a cohort in At-risk patients undergoing major non-cardiac surgery (n=629). Myocardial perfusion imaging (MPI) vs. Revised cardiac risk index (RCRI) / baseline risk factors was evaluated on Major adverse cardiac events (MACE) within 30 days of surgery (OR 2.9, 95% CI 1.1-7.1, p=0.02). Myocardial perfusion imaging-identified reversible perfusion defects were associated with 30-day MACE (OR 2.9; 95% CI 1.1-7.1) but failed to improve risk classification beyond baseline risk factors.
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