Preoperative cardiac screening before peripheral vascular operations.

: Myocardial infarction continues to be a major cause of morbidity and mortality after peripheral vascular operations. In this study, radionuclide angiography (RNA) of the heart was used to delineate the cardiac risk. In 78 patients, there were 53 abnormal RNA studies. Twenty-seven patients with abnormal RNA underwent coronary angiography. Six aortocoronary bypasses were performed prior to or in conjunction with the vascular operation without complications. Ninety major operations were carried out in these 78 patients. There was no myocardial infarction in patients with normal RNA. There were two postoperative fatal myocardial infarctions in patients with abnormal RNA giving a procedure mortality of 2.2 per cent. In 11 patients, the proposed operation was changed. Thirteen patients with abnormal RNA had no cardiac symptoms. Three patients in this subgroup underwent aortocoronary bypass. It was concluded that RNA can effectively identify the cardiac risk in patients undergoing peripheral vascular operations. Routine coronary angiography may be unnecessary as patients with normal RNA have minimal risk of myocardial infarction.