Dipyridamole-thallium/sestamibi before vascular surgery: a prospective blinded study in moderate-risk patients

J Vasc Surg. 2000 Jul;32(1):77-89. doi: 10.1067/mva.2000.107311.


Purpose: This study assessed in a prospective, blinded fashion whether a reversible defect on dipyridamole-thallium (DTHAL)/sestamibi (DMIBI) can predict adverse cardiac events after elective vascular surgery in patients with one or more clinical risk factors.

Methods: Consecutive patients with one or more clinical risk factors underwent a preoperative blinded DTHAL/DMIBI. Patients with recent congestive heart failure (CHF) or myocardial infarction (MI) or severe or unstable angina were excluded.

Results: Eighty patients (78% men; mean age, 65 years) completed the study. Diabetes mellitus was the most frequent clinical risk factor (73%), followed by age older than 70 years (41%), angina (29%), Q wave on electrocardiogram (26%), history of CHF (7%), and ventricular ectopy (3%). The results of DTHAL/DMIBI were normal in 36 patients (45%); a reversible plus or minus fixed defect was demonstrated in 28 patients (36%), and a fixed defect alone was demonstrated in 15 patients (19%). Nine adverse cardiac events (11%) occurred, including three cases of CHF, and one case each of unstable angina, Q wave MI, non-Q wave MI, and cardiac arrest (successfully resuscitated). Two cardiac deaths occurred (2% overall mortality), one after a Q wave MI and one after CHF and a non-Q wave MI. The cardiac event rate was 14% for reversible defect and 9.8% without reversible defect (P =.71). The cardiac event rate was 12.5% (one of eight cases) for two or more reversible defects, versus 11.1% (eight of 72 cases) for fewer than two reversible defects (P = 1.0). The sensitivity rate of two or more areas of redistribution was 11% (95% CI, 0.3%-48%), the specificity rate was 90%, and the positive and negative predictive values were 12.5% and 89%, respectively.

Conclusion: Our study demonstrated no association between reversible defects on DTHAL/DMIBI and adverse cardiac events in moderate-risk patients undergoing elective vascular surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Dipyridamole*
  • Female
  • Heart Diseases / diagnostic imaging*
  • Humans
  • Male
  • Postoperative Complications / diagnostic imaging*
  • Predictive Value of Tests
  • Prospective Studies
  • Radionuclide Imaging
  • Radiopharmaceuticals / therapeutic use*
  • Risk Assessment
  • Sensitivity and Specificity
  • Technetium Tc 99m Sestamibi*
  • Thallium Radioisotopes*
  • Vascular Surgical Procedures*
  • Vasodilator Agents*


  • Radiopharmaceuticals
  • Thallium Radioisotopes
  • Vasodilator Agents
  • Dipyridamole
  • Technetium Tc 99m Sestamibi