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December 1990

Cardiac Risk in Vascular Surgery: The Oral Dipyridamole-Thallium Stress Test

Author Affiliations

From the Departments of Surgery (Dr Makaroun) and Nuclear Medicine (Dr Schreiner) and Division of Cardiology (Dr Arvan), Veterans Affairs Medical Center; and the University of Pittsburgh School of Medicine (Drs Makaroun, Schreiner, and Arvan and Mss Shuman-Jackson and Rippey). Deceased.

Arch Surg. 1990;125(12):1610-1613. doi:10.1001/archsurg.1990.01410240092018

• The value of the oral dipyridamole-thallium stress test in identifying patients at high risk of myocardial infarction after vascular procedures has not been documented. We studied prospectively 46 patients who underwent an oral dipyridamole-thallium stress test before undergoing vascular operations. Twenty patients (43%) had a positive test result, defined by a thallium defect with reperfusion, while 26 patients had a negative test result. Myocardial infarctions were documented postoperatively in 5(25%) of 20 of the group with positive results and 1 (4%) of 26 of the group with negative results. Three of the six myocardial infarctions were clinical; all three were in the group with positive results. No correlation was identified between dipyridamole-thallium stress test results and clinical cardiac history. A positive dipyridamole-thallium stress test result is a more sensitive predictor of postoperative myocardial infarction than ejection fraction or history of coronary artery disease. The oral dipyridamole-thallium stress test is as useful as the intravenous test in this setting.

(Arch Surg. 1990;125:1610-1613)