Noninvasive tests for risk stratification in major vascular surgery

S. Mondillo, Piercarlo Ballo, E. Agricola, F. Guerrini, R. Barbati, T. Ammaturo, P. Bertelli, E. Neri, C. Sassi

Research output: Contribution to journalArticle

Abstract

Background: The predictive values of noninvasive tests versus perioperative cardiac events in patients undergoing major vascular surgery has not been definitively established. Patients and methods: According to clinical markers and left ventricular function at rest, 188 patients were assigned to the following groups: 40 low, 115 moderate and 33 high risk. They were then randomly submitted to dipyridamole (n = 64), dobutamine (n = 63) stress echocardiography and dipyridamole perfusion scintigraphy (n = 61). Results: No events were observed in low-risk patients, whereas 12 (10.4%) and 8 (24%) events in moderate- and high-risk categories occurred, respectively. Only the high-risk category, as a predictive variable, was significantly related to the onset of cardiac complications (p <0.05). A positive dipyridamole/dobutamine stress test was related to cardiac events, but multivariate analysis showed that only severity and extent of ischemia were the best predictors of events (p <0.01 for dipyridamole and p <0.005 for dobutamine). The presence of reversible, but not fixed, perfusion defects at scintigraphy was significantly related to perioperative events; at multivariate analysis, only > 3 reversible perfusion defects represented a strong predictor of events (p <0.05). Conclusions: Among subjects undergoing major vascular surgery, severity and extent of ischemia during dipyridamole/dobutamine stress echocardiography and presence of > 3 reversible perfusion defects are strong predictors of cardiac events, particularly in moderate-risk category of patients.

Original languageEnglish
Pages (from-to)195-201
Number of pages7
JournalVasa - Journal of Vascular Diseases
Volume31
Issue number3
Publication statusPublished - Aug 2002

Keywords

  • Risk stratification
  • Stress echocardiography
  • Vascular surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Mondillo, S., Ballo, P., Agricola, E., Guerrini, F., Barbati, R., Ammaturo, T., Bertelli, P., Neri, E., & Sassi, C. (2002). Noninvasive tests for risk stratification in major vascular surgery. Vasa - Journal of Vascular Diseases, 31(3), 195-201.