Limited utility of dipyridamole-thallium for predicting adverse cardiac events after vascular surgery

The objective of this retrospective study was to determine the value of dipyridamole-thallium (PTHAL) and Eagle criteria (Q wave on EGG, ventricular ectopy, diabetes, congestive heart failure, age greater than or equal to 70, angina) in predicting cardiac events after vascular surgery at a Veteran Affairs hospital. The main outcome measures were adverse cardiac events. Of 211 vascular procedures, 148 were performed without, and 63 performed with, preoperative PTHAL. Thirty-six patients had redistribution on PTHAL, but only two underwent preoperative coronary revascularization. There were 10 cardiac events (4.8%), five in each group (p=NS). Cardiac events were increased with greater than or equal to one Eagle criteria (6.7% vs 0% with no Eagle, p=0.04), but not with PTHAL redistribution. Conclusions: Prior to elective vascular surgery: (1) PTHAL redistribution did not predict cardiac events. (2) Cardiac morbidity was increased with greater than or equal to one Eagle criteria. (3) Cardiac testing is not indicated in patients without Eagle criteria.