Cardiac risk screening of peripheral arterial surgical patients by the use of combined simple clinical and non-invasive cardiodynamic parameters.
Arterial surgical patients have a poor long-term survival and suffer significant risks of experiencing perioperative cardiac events, mainly due to a high incidence of coronary atherosclerosis impairing left ventricular function. The perioperative cardiac risk can be assessed by use of clinical cardiac risk indices, which are inexpensive but may have suboptimal sensitivity, or by more extensive cardiac tests. In this study the efficacy of a combined, non-invasive and inexpensive technique of risk assessment was prospectively evaluated in 195 patients undergoing peripheral arterial surgery (aortic aneurysms not included). All patients were preoperatively examined by a nurse registering the Detsky cardiac risk index score (DRI) and performing resting computerised bioimpedance cardiodynamic measurements (CM). Cardiac deaths (CD, n = 6), potentially lethal cardiac complications (PLC, n = 11) within 30 days and long-term survival during 20 +/- 12 (S.D.) months of follow-up were identified. CD was best predicted by combining CM and DRI, while PLC was best predicted by combining DRI and the haemoglobin concentration of the blood (Hb). A group without CD containing 88% of the cases was identified. Furthermore, the combination of DRI < or = 10 and Hb > 120 g/l identified a low risk group (57% of all cases) with no PLC or CD. Using CM, DRI and Hb in combination, patient groups with long-term survival from 0-90% were identified. We conclude that this inexpensive cardiac risk screening both identifies low risk vascular surgical patients, for whom more sophisticated preoperative cardiac testing can be omitted, and predicts long-term survival.
Jivegård
L
L
Department of Surgery, Sahlgrenska Hospital, Göteborg, Sweden.
Haljamäe
H
H
Holm
J
J
Johansson
S R
SR
D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation / Q000502:physiology; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D016894:Endarterectomy, Carotid; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006452:Hemoglobinometry; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate