title: Preoperative assessment of the risk for cardiac death following thrombo-embolectomy for acute lower limb ischaemia.
abstract: Cardiac monitoring and the selective use of initial non-operative management is reported to reduce the high mortality rate in patients with acute lower limb ischaemia. Early estimation, prior to selection of initial therapy, of the risk for intraoperative or postoperative cardiac death following thrombo-embolectomy is therefore important. The aim of this prospective multi-centre study was to develop a simple and clinically useful index for assessment of the risk of post-operative cardiac death. Patients judged to need thrombo-embolectomy for acute lower limb ischaemia were evaluated on admission for routine clinical, cardiac and limb ischaemia parameters that could be related to cardiac function and these parameters compared to postoperative cardiac outcome. Sixteen per cent of the 117 patients died from intraoperative or postoperative cardiac complications. Analysis revealed five admission parameters that significantly and independently predicted a high risk for cardiac death: mean arterial blood pressure below 90 mmHg, clinical sign(s) of cardiac decompensation, ischaemia affecting the thigh, haemoglobin concentration exceeding 140 gl-1, and a history of a myocardial infarction in the previous 4 weeks. Definition of risk points for each risk factor allowed a simple classification of each patient into one of three significantly different cardiac risk classes with cardiac death rates of 6 +/- 3%, 27 +/- 8% and 75 +/- 16%, respectively. More than two thirds of the patients belonged to the low risk group. The described risk index provides a tool for preoperative assessment of the cardiac death risk associated with early thrombo-embolectomy in patients with acute lower limb ischaemia.
authors.affiliation: Department of Surgery, Sahlgrenska Hospital, Göteborg, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Jivegård
authors.forename: D
authors.initials: D
authors.lastname: Bergqvist
authors.forename: J
authors.initials: J
authors.lastname: Holm
authors.forename: B
authors.initials: B
authors.lastname: Lindblad
authors.forename: B
authors.initials: B
authors.lastname: Lundqvist
authors.forename: G
authors.initials: G
authors.lastname: Plate
authors.forename: L
authors.initials: L
authors.lastname: Spangen
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D013923:Thromboembolism / Q000401:mortality / Q000601:surgery*