704 STRESS TEST STRATEGY WITH CMR AND SPECT-MPI REDUCES CARDIAC EVENTS IN CANDIDATES TO NON-CARDIAC SURGERIES

Abstract

Abstract Introduction . Cardiac complications related to non-cardiac surgery have a variable incidence, from less than 1% to more than 5% with a great variability depending on type of intervention, patient's risk factors and results from tests performed during the pre-operative evaluation. The aim of our single centre retrospective study was to evaluate the prognostic role of stress cardiac magnetic resonance (sCMR) and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in relation to 30 days post-surgery cardiac events. Method Clinical data of patients from January 2015 to December 2021 were retrospectively collected from review of electronical medical records. Only intermediate and high risk surgeries were included. All patients underwent to cardiologic, electrocardiographic and echocardiographic evaluation before surgery. Stress test was performed according to cardiologist judgment. Primary endpoint was a composite endpoint of myocardial infarction, unstable angina, cardiac death, cardiogenic shock, pulmonary oedema and life threatening cardiac arrythmias. Secondary endpoint were the research of ischemia predictors and the rate of revascularization. Results One-thousand-five-hundred-ninety patients were included, 669 stress tests were performed (287 sCMR, 382 SPECT-MPI). Rate of 30-days cardiac events was lower in the stress test group vs non-stress test group (1,2% vs 3,4%; p 0,006). Imaging stress test strategy showed a significant reduction of composite endpoint at multivariate analysis (OR: 0.334, IC: 0.155–0.766, p 0.009). Predictors of ischemia were hypertension, coronary artery disease and diastolic dysfunction. SCMR was non inferior to SPECT with regard the risk of cardiac events, while showed a greater accuracy to predict coronary revascularization (AUC for sCMR: 0.94). Conclusions Stress test strategy reduces cardiac events in high risk patients candidate to moderate- to high- risk surgeries. Stress CMR is non-inferior to SPECT with regards to the risk of cardiac events, but has a greater accuracy to predict the need for revascularization.