biostudies-literatureKim DNHLBI NIH HHSFoundation for the National Institutes of Health2652-2661https://www.ebi.ac.uk/biostudies/studies/S-EPMC12810971biostudies-literatureUnknown53(4)<h4>Purpose</h4>Myocardial perfusion imaging (MPI) is frequently used to improve cardiac risk prediction in patients undergoing non-cardiac surgery. However, the data supporting this practice is derived from single center studies and predates current therapy for coronary artery disease (CAD). We evaluated the association between pre-operative testing indication and outcomes as well as predictors of death or myocardial infarction (MI) in these patients.<h4>Methods</h4>We include patients from the international, multicenter REFINE-SPECT registry (13 sites). Based on referral indication, patients were classified as pre-operative testing indications and non-pre-operative testing. We evaluated the associations between pre-operative testing and incidence of death or MI. We then evaluated associaEuropean journal of nuclear medicine and molecular imagingRisk stratification with pre-operative myocardial perfusion imaging.PMC12810971R35HL161195R35 HL161195R01HL089765R01 HL089765Halcox JKim DDi Carli MFMiller RJHSharir TSinusas AJHauser MTBateman TMRuddy TDBerman DSDey DEinstein AJDorbala SKaufmann PAFish MBAcampa WBuiloff VMiller EJSlomka PJfalseRisk stratification with pre-operative myocardial perfusion imaging.<h4>Purpose</h4>Myocardial perfusion imaging (MPI) is frequently used to improve cardiac risk prediction in patients undergoing non-cardiac surgery. However, the data supporting this practice is derived from single center studies and predates current therapy for coronary artery disease (CAD). We evaluated the association between pre-operative testing indication and outcomes as well as predictors of death or myocardial infarction (MI) in these patients.<h4>Methods</h4>We include patients from the international, multicenter REFINE-SPECT registry (13 sites). Based on referral indication, patients were classified as pre-operative testing indications and non-pre-operative testing. We evaluated the associations between pre-operative testing and incidence of death or MI. We then evaluated associa2026-01-01T00:00:00Z2026 Mar2026-07-16T09:42:19.337Z2026-07-09T10:46:52.39ZS-EPMC128109714114398310.1007/s00259-025-07530-6