A Meta-Analytic Comparison of Preoperative Stress Echocardiography and Nuclear Scintigraphy Imaging
- 1 January 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesia & Analgesia
- Vol. 102 (1), 8-16
- https://doi.org/10.1213/01.ane.0000189614.98906.43
Abstract
In this meta-analysis we compared thallium imaging (TI) and stress echocardiography (SE) in patients at risk for myocardial infarction (MI) scheduled for elective noncardiac surgery. Two searches of published articles were used to identify relevant articles. We included all studies that stated the criteria for a positive test and detailed the frequency of postoperative MI and in-hospital death. Data were abstracted by two authors and captured preoperative patient characteristics, study design, blinding, and outcome adjudication. We defined a positive test as a test with a reversible defect and, where possible, quantified the size of the defects in each study. MI and/or death were the only postoperative outcomes of interest. We calculated the sensitivity, specificity, and likelihood ratio (LR) and, where possible, the Receiver Operating Characteristic (ROC) curve of a cardiac event in each study. The LR and ROC were combined by meta-analyses using the random effects model. Heterogeneity was assessed using the I2 test. The search revealed 68 studies of 10,049 patients. There were 25 SE studies and 50 TI studies. There were 7 studies with a direct comparison of the two methodologies. The quality of studies differed; routine screening for MI was used more frequently in SE studies (47.8% versus 21.2%; P = 0.008) and screening dictated treatment more often after TI (72.1%) than after SE (46.3%) (P = 0.027). The LR for SE was more indicative of a postoperative cardiac event than TI (LR, 4.09; 95% CI, 3.21-6.56 versus 1.83; 1.59-2.10; P = 0.001). This difference was attributable to fewer false-negative SEs. There was no difference in the cumulative ROC curves from qualitative studies (SE, 0.80; 95% CI, 0.76-.84 versus TI, 0.75; 95% CI, 0.70-081). Again, the LR for a negative SE was less (0.23; 95% CI, 0.17-0.32 versus 0.44; 95% CI, 0.36-0.54). A moderate-to-large defect, seen in 14% of patients, by either method predicts a postoperative cardiac event (LR, 8.35; 95% CI, 5.6-12.45). This meta-analysis possesses the statistical power to demonstrate that SE has better negative predicative characteristics than TI. A moderate-to-large perfusion defect by either SE or TI predicts postoperative MI and death. We conclude the SE is superior to TI in predicting postoperative cardiac events.Keywords
This publication has 83 references indexed in Scilit:
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- Assessment of cardiac risk before nonvascular surgeryJournal of the American College of Cardiology, 2000
- Dipyridamole technetium 99m sestamibi myocardial tomography for preoperative cardiac risk stratification before major or minor nonvascular surgeryAmerican Heart Journal, 1996
- Cardiac complications in noncardiac surgery: Relative value of resting two-dimensional echocardiography and dipyridamole thallium imagingAmerican Heart Journal, 1996
- Determination of perioperative cardiac risk by adenosine thallium-201 myocardial imagingAmerican Heart Journal, 1992
- Dobutamine stress echocardiography for assessment of cardiac risk before noncardiac surgeryThe American Journal of Cardiology, 1991
- Perioperative and long-term prognostic value of intravenous dipyridamole thallium scintigraphy in patients with peripheral vascular diseaseAmerican Heart Journal, 1990
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986
- Determination of Cardiac Risk by Dipyridamole-Thallium Imaging before Peripheral Vascular SurgeryNew England Journal of Medicine, 1985
- Multifactorial Index of Cardiac Risk in Noncardiac Surgical ProceduresNew England Journal of Medicine, 1977