Cost-Effectiveness of MPI SPECT for Cardiac Evaluation in Patients Undergoing Non-cardiac Surgeries

The increasing number of patients with coronary artery disease (CAD) undergoing major non-cardiac surgery justifies the guidelines concerning preoperative cardiac evaluation. This is compounded by increasing chances for a volatile perioperative period if the underlying cardiac problems are left uncorrected prior to major non-cardiac surgeries. Preoperative cardiac evaluation requires the clinician to assess the patient’s probability to have CAD, severity and stability of CAD, placing these in perspective regarding the likelihood of a perioperative cardiac complication based on the planned surgical procedure. Coronary events like new onset ischemia, infarction, or revascularization, induce a high-risk period of 6 weeks, and an intermediate-risk period of 3 months before performing non-cardiac surgery. This delay is unwarranted in cases where surgery is the mainstay of treatment. The objective of this review is to offer a comprehensive algorithm in the preoperative assessment of patients undergoing pre-operative evaluation and highlight the importance of myocardial perfusion imaging in risk stratifying these patients.