A negative preoperative 99mTechnetium tetrofosmin myocardial perfusion imaging scan with postoperative acute coronary syndrome - A case of balanced ischaemia

Perioperative myocardial infarction (PMI) is an important indicator of outcome after noncardiac surgery. Identifying patients at risk of PMI helps in risk stratification and modification. Myocardial perfusion imaging (MPI) is an established diagnostic modality for detection and prognostication of coronary artery disease (CAD). We report a case wherein preoperative MPI was negative for CAD but patient presented with acute coronary event in the postoperative period. We identify and evaluate the reasons for the failure of MPI in detection of CAD in our patient.