비심장 수술 후 심장 합병증 발생에 있어 심장관류영상의 유용성

Abstract

Preoperative MPI is known as an important modality to predict postoperative cardiac complications, but previous studies for evaluating preoperative MPI are limited by relatively small sample sizes and low event rates. And a recent prospective cohort study showed limitations of predictive value of subjective assessments of functional capacity before noncardiac surgery. As MPI ungated by functional capacity is seemingly warranted, particularly in patients with a considerable surgical risk, it is important to evaluate predictive value of preoperative MPI more appropriately. This retrospective observational cohort study from single, tertiary, high surgical volume center in South Korea included 82,441 patients aged >40 years who underwent MPI within 6 months before elective noncardiac surgery from January 2000 to December 2021. Results of MPI were classified as abnormal (any fixed or reversible perfusion defect) vs normal MPI. The primary outcome was a composite of cardiac death or myocardial infarction (MI) within 30 days. Prognostic accuracy was assessed using logistic regression models, area under the receiver- operating-characteristic curve (AUC) analysis, and net reclassification improvement (NRI). Among the 82441, 184 (0.2%) experienced cardiac death or MI. MPI were abnormal in 5603 patients (6.8%). Compared with a normal MPI, an abnormal MPI had a higher risk of the primary outcome [crude incidence, 1.2% vs 0.1%; adjusted odds ratio, 4.64; 95% confidence interval (CI), 3.29-6.50; P<.001]. The presence of an abnormal MPI improved discrimination for the primary outcome (AUC 0.77 vs 0.73; P<0.001) and significantly improved risk classification (NRI 0.26; 95% CI, 0.11-0.40; P<.001). Among patients with an abnormal MPI, 378 (6.7%) underwent pre-operative coronary revascularization, which was not associated with a lower risk of the primary outcome (P=.56). An abnormal MPI appeared to be an important risk factor for postoperative cardiac events and provided additive prognostic value. Nevertheless, preoperative MPI was limited by its low positive predictive value, leading to potentially unnecessary coronary revascularization procedures with unproven prognostic value.