Post-stress perfusion abnormalities detected on myocardial perfusion single-photon emission computed tomography predict long-term mortality after elective abdominal aortic aneurysm repair

Background: After abdominal aortic aneurysm (AAA) repair, relatively low survival during long-term follow-up remains an unresolved issue. Stress myocardial perfusion single-photon emission computed tomography (SPECT) well predicts future mortality overall, as well as providing diagnoses of coronary artery disease. The prognostic value of myocardial SPECT findings after AAA repair, however, remains unclear. Methods and Results: This study followed 285 patients, all undergoing preoperative pharmacologic stress myocardial perfusion SPECT to determine summed stress score (SSS), then elective AAA repair by open AAA repair or endovascular aneurysm repair. The endpoint of the study was cardiac death. The median follow-up duration was 925 days (range, 541-1,095 days). Twenty-four (8%) died during follow-up. Kaplan-Meier analysis showed that patients with SSS ≥9 had a significantly poorer prognosis than those with SSS <9 (76% vs. 93%, P=0.003). Multivariate Cox proportional hazards analysis indicated that SSS ≥9, diabetes, and chronic kidney disease ≥ stage 3 could significantly and independently predict long-term cardiovascular mortality in patients after AAA repair (hazard ratio [HR], 4.2; 95% confidence interval [CI]: 1.8-9.7, P=0.001; HR, 3.0; 95% CI: 1.2-7.4, P=0.020; and HR, 4.1; 95% CI: 1.7-10.1, P=0.029, respectively). Conclusions: Preoperative pharmacologic stress myocardial perfusion SPECT is a useful method to predict longterm cardiovascular mortality for patients undergoing elective AAA repair.