TY - JOUR
T1 - Noninvasive tests for risk stratification in major vascular surgery
AU - Mondillo, S.
AU - Ballo, Piercarlo
AU - Agricola, E.
AU - Guerrini, F.
AU - Barbati, R.
AU - Ammaturo, T.
AU - Bertelli, P.
AU - Neri, E.
AU - Sassi, C.
PY - 2002/8
Y1 - 2002/8
N2 - 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.
AB - 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.
KW - Risk stratification
KW - Stress echocardiography
KW - Vascular surgery
UR - http://www.scopus.com/inward/record.url?scp=0036674218&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0036674218&partnerID=8YFLogxK
M3 - Article
C2 - 12236025
AN - SCOPUS:0036674218
VL - 31
SP - 195
EP - 201
JO - Vasa - European Journal of Vascular Medicine
JF - Vasa - European Journal of Vascular Medicine
SN - 0301-1526
IS - 3
ER -