Preoperative thallium scanning, selective coronary revascularization, and long-term survival after major vascular surgery.
BACKGROUND
Ischemia on thallium scanning is a strong predictor of long-term mortality in CAD patients. Whether coronary revascularization (CR) in patients with significant ischemia on preoperative thallium scanning (PTS) improves long-term survival after major vascular surgery has not been determined.


RESULTS
The perioperative data, including PTS and subsequent CR in patients with moderate to severe reversible ischemia on PTS, and long-term survival of 502 consecutive patients who underwent 578 major vascular procedures were analyzed retrospectively. Patients with PTS who ultimately did not undergo the planned vascular operation were also studied. Cox regression and propensity score analyses were used to analyze survival. A total of 407 patients (81.1%) had PTS: 221 (54.3%) had no or mild defects (group I); 50 (12.3%) had moderate-severe fixed defects (group II); 62 (15.2%) had moderate-severe reversible ischemia yet did not undergo CR (group III); and 74 (18.2%) had moderate-severe reversible ischemia and subsequent CR by CABG (36) or PTCA (38; group IV). Patients who sustained major complications as a result of the preoperative cardiac workup were included in group IV. By multivariate analysis, age, type of vascular surgery, presence of diabetes, previous myocardial infarction, and moderate-severe ischemia on PTS independently predicted mortality (P=0.001, 0.009, 0.039, 0.006, and 0.029, respectively), and preoperative CR predicted improved survival (OR 0.52, P=0.018). Group IV had better survival than group III even when subdivided according to normal and reduced left ventricular function (OR 0.40 and 0.41, P=0.035 and 0.021, respectively).


CONCLUSIONS
Long-term survival after major vascular surgery is significantly improved if patients with moderate-severe ischemia on PTS undergo selective CR.
Landesberg
Giora
G
Department of Anesthesiology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel. gio@cc.huji.ac.il
Mosseri
Morris
M
Wolf
Yehuda G
YG
Bocher
Moshe
M
Basevitch
Alon
A
Rudis
Ehud
E
Izhar
Uzi
U
Anner
Haim
H
Weissman
Charles
C
Berlatzky
Yacov
Y
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000628:therapy; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D013794:Thallium Radioisotopes; D014656:Vascular Surgical Procedures / Q000401:mortality*
D013794:Thallium Radioisotopes