Noninvasive tests for risk stratification in major vascular surgery.
BACKGROUND
The predictive values of noninvasive tests versus perioperative cardiac events in patients undergoing major vascular surgery has not been definitively established.


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.
Mondillo
S
S
Istituto di Clinica Medica, Università di Siena, Italy.
Ballo
P
P
Agricola
E
E
Guerrini
F
F
Barbati
R
R
Ammaturo
T
T
Bertelli
P
P
Neri
E
E
Sassi
C
C
D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D003327:Coronary Disease / Q000145:classification / Q000175:diagnosis*; D004176:Dipyridamole; D025401:Echocardiography, Stress; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D018570:Risk Assessment; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000145:classification / Q000175:diagnosis
D004176:Dipyridamole