Incidence of perioperative myocardial infarction among high risk patients who undergo preoperative evaluation for non-cardiac surgery by cardiologists.

BACKGROUND: High risk patients who undergo a non-cardiac surgery often develop a perioperative myocardial infarction (PMI). OBJECTIVE: To study the incidence of PMI among high risk patients who undergo preoperative evaluation for non-cardiac surgery by cardiologists. MATERIAL AND METHOD: This study was a cross-sectional study, performed at Thammasat Hospital for one year Eligible patients were subjects older than 40 years with pre-existing cardiovascular disease or with at least one major cardiovascular risk factor including chronic kidney disease who underwent non-cardiac surgery with preoperative cardiovascular evaluation. The primary outcome is perioperative myocardial infarction. RESULTS: Fifty-three patients (mean age 70.5 years, 54.7% female) were eligible for the study. Most of these patients underwent orthopedic surgery (24 patients, 45.3%) and general surgery (18 patients, 34%). Four female patients developed PMI, representing the incidence of 7.5 percent. Chronic kidney disease and peripheral arterial disease were statistically significant associated with PMI. CONCLUSION: The incidence of PMI in this study was slightly higher than those reported in previous studies. Therefore, physicians should be aware of the diagnosis and proper management of this condition.

CT dose reduction using prospectively triggered or fast-pitch spiral technique employed in cardiothoracic imaging (the CT dose study).

OBJECTIVES: To establish current radiation dose levels with contemporary scanners capable of prospectively triggered or high-pitch spiral scan modes to previous generation scanners among patients evaluated for coronary artery disease, pulmonary embolism, aortic disease, and "triple rule out" in a large population of patients at multiple centers. BACKGROUND: Previous small-scale studies with carefully controlled scan protocols report that CT scanners that facilitate prospectively triggered scanning and provide high-pitch spiral CT scan modes drastically lower radiation doses. However, diagnostic reference levels should be selected by medical bodies on the basis of large surveys of representative sites and reviewed at appropriate time intervals. METHODS: Scan data including dose and image quality parameters were collected retrospectively from 64 slice scanners (control) and prospectively after sites installed 128-slice dual-source scanners with high-pitch capability (study). Protocol selection was purposely not specified to survey "real world" results. Blinded quantitative image analysis was performed on every fifth scan. RESULTS: From April 2011 to March 2012, 2085 patients at 9 sites completed the study: 1051 coronary artery disease (509 control, 542 study), 528 pulmonary embolism (267 control, 261 study), 419 aortic disease (268 control, 151 study), and 87 triple rule out (53 control, 34 study). There was a significant reduction in median dose-length product (DLP) from 669 mGy ∙ cm (interquartile range [IQR]: 419-1026 mGy ∙ cm) in the control group to 260 mGy ∙ cm (IQR: 159-441 mGy ∙ cm) in the study group, a reduction by 61% (P < .0001) and was lower in all categories. No significant differences were noted in image quality. CONCLUSION: Use of advanced scanners facilitating prospectively triggered or high-pitch spiral scan modes results in marked dose reduction across a variety of cardiovascular studies, with no compromise in image quality. These findings may contribute to new target dose recommendations in societal guidelines.