Abstract
Background: Cancer patients are at a higher risk for any cardiac event during and post surgery, due to an altered coagulation state and anemia, and can have additive effect if the patient had previous history of any cardiac event or risk factor for coronary artery disease such as hypertension and diabetes. Methods: 100 consecutive patients, who were being planned for the oncological surgery, were enrolled in this study for preoperative gated myocardial perfusion scintigraphy using99mTcsestamibi with adenosine stress. After acquiring the data, MPI were reconstructed and analyzed using visual assessment as well as QPS program and summed stress score (SSS) was obtained. Based on visual assessment and SSS, we divided patients into low- and high-risk groups. Results: 100 patients (57 female and 43 male) with a mean age 61.25 years. 63% had a history of diabetes,73% hypertension, 34% were known smokers while 42% had a family history of coronary artery disease and 15 patients has CAD. 61% fell into the low-risk group and 39%in the high-risk group. In the low-risk group 1 patient needed inotropic support post operatively while in high-risk group, 6 patients had cardiac events postoperatively. Subset analysis of these showed; 3 (7.69%) had an episode of angina prior to discharge, 2 died with cardiac-arrest due to myocardial infraction and 1 needed inotropic support postoperatively and surgery was deferred in 4 patients due to their very low LVEF and high SSS. These 4 patients were further evaluated by cardiologist for future management.Conclusion: In low-risk group patients, stress MPI has a high negative predictive value for peri- and post operative cardiac events in cancer patients. While patients with cancer and labeled as high-risk on myocardial perfusion imaging, whether demonstrating scar or ischemia, should prompt appropriate peri- and post operative management to minimize major cardiac events.

Key words: Myocardial perfusionscintigraphy, Pre-operative risk assessment,99mTc-sestamibi, Pharmacological stress,Adenosine, Coronary artery disease