title: Which stress test is superior for perioperative cardiac risk stratification in patients undergoing major vascular surgery?
abstract: OBJECTIVE
  to compare the additional prognostic value of Dobutamine Stress Echocardiography (DSE), Dipyridamole Stress Echocardiography (DiSE) and Perfusion Scintigraphy (DTS) on clinical risk factors in patients undergoing major vascular surgery.
  
  
  METHODS
  retrospective analysis.
  
  
  METHODS
  2204 consecutive patients who underwent DSE (n=1093), DiSE (n=394), or DTS (n=717) testing before major vascular surgery were studied.
  
  
  METHODS
  primary endpoint was a composite of cardiac death and non-fatal myocardial infarction (MI). Logistic regression analysis was performed to evaluate the relation between cardiac risk factors, stress test results and the incidence of the composite endpoint.
  
  
  RESULTS
  there were 138 patients (6.3%) with cardiac death or MI. Patients with 0, 1-2, and 3 or more risk factors experienced respectively 3.0, 5.7 and 17.4% cardiac events. We found no statistically significant difference in the predictive value of a positive test result for DiSE and DSE (Odds ratio (OR) of 37.1 [95% CI, 8.1-170.1] vs 9.6 [95% CI, 4.9-18.4]; p=0.12), whereas a positive test result for DTS had significantly lower prognostic value (OR=1.95 [95% CI, 1.2-3.2]).
  
  
  CONCLUSIONS
  a result of stress echocardiography effectively stratified patients into low- and high-risk groups for cardiac complications, irrespective of clinical risk profile. In contrast, the prognostic value of DTS results was more likely to be dependent on patients' clinical risk profile.
authors.affiliation: Departments of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: M D
authors.initials: MD
authors.lastname: Kertai
authors.forename: E
authors.initials: E
authors.lastname: Boersma
authors.forename: R
authors.initials: R
authors.lastname: Sicari
authors.forename: G J
authors.initials: GJ
authors.lastname: L'Italien
authors.forename: J J
authors.initials: JJ
authors.lastname: Bax
authors.forename: J R T C
authors.initials: JR
authors.lastname: Roelandt
authors.forename: H
authors.initials: H
authors.lastname: van Urk
authors.forename: D
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D002316:Cardiotonic Agents; D015331:Cohort Studies; D004176:Dipyridamole; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery*; D008297:Male; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care; D010726:Phosphodiesterase Inhibitors; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011379:Prognosis; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D004280:Dobutamine; D004176:Dipyridamole