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The role of myocardial perfusion scanning, heart rate variability and D-dimers in predicting the risk of perioperative cardiac complications after peripheral vascular surgery

Objectives: to study the value of a number of proposed prog-nos tic factors in prediction of the risk of perioperative cardiac events after vascular surgery. Design and Methods: two hundred and ninety-seven patients undergoing peripheral vascular surgery were prospectively studied. Patients underwent preoperative 24 h ambulatory electrocardiography, measurement of haemostatic variables, myocardial assessment of perfusion by dipyridamole-thallium scintigraphy and radionuclide ventriculography, The primary endpoint was cardiac death or nonfatal myocardial infarction within 30 days of surgery. A combined endpoint included the primary endpoint plus occurrence of cardiac failure, unstable angina or serious arrhythmias, Results: the primary endpoint occurred in 21 (7 %), and the combined endpoint in 41 (14 %) of patients. On multivariate analysis, increased age, previous myocardial infarction, aortic surgery, impaired heart rate variability and a positive thallium scan were independent predictors of primary end- points. Preoperative atrial fibrillation and increased fibrin D-dimer were additional predictors of the combined endpoint. Construction of receiver-operator characteristic curves to examine the incremental value of predictive models showed that sensitivity and specificity of clinical data alone for primary endpoints was 71 % and 72 % respectively, while for the full model (incorporating heart rate variability and thallium data) this rose to 84 % and 80 % (P = 0.0001). Conclusions: preliminary screening using clinical data has limited value in risk assessment prior - to vascular surgery but preoperative heart rate variability, D-dimers and thallium scanning provide modest incremental predictive value