Transitory myocardial ischemia in patients with vascular lower limb amputation: relationship with long-term atherothrombotic events.
OBJECTIVE
To evaluate the prevalence of asymptomatic transitory myocardial ischemia during scintigraphy among amputees of vascular etiology as well as to ascertain correlation with atherothrombotic events during long-term follow-up.


METHODS
A cohort, mean follow-up of 2.1 yrs study was performed in an outpatient rehabilitation clinic with 58 lower limb vascular amputees who were referred for rehabilitation, asymptomatic for coronary heart disease. Patients were evaluated for myocardial ischemia by dipyridamole scintigraphy, and occurrence of severe cardiovascular events (death, acute myocardial infarction, stroke, and peripheral ischemia with hospitalization) was assessed.


RESULTS
Of the 58 patients, 26 (44.8%) had positive dipyridamole myocardial scintigraphy for transitory myocardial ischemia. During follow-up, 12 subjects (20.7%), mainly diabetic patients (83%), registered a serious cardiovascular event, with 9 of 12 events having occurred in those who had tested positive for transitory ischemia on scintigraphy (P < 0.025). There were five deaths (19.2%) in those with a positive scintigraphy and a single death (3.1%) in those with a negative dipyridamole test, although the Kaplan-Meier survival curve and Cox regression were not significant (P = 0.09 and 0.1, respectively).


CONCLUSIONS
We found that 44.8% of patients with vascular lower limb amputation, asymptomatic for coronary disease, tested positive on myocardial scintigraphy for transitory myocardial ischemia. In a mean follow-up of 2.1 yrs, there was 10.3% of atherothrombotic events/year, with a higher death toll in those patients with positive scintigraphy.
Ingham
Sheila Jean McNeill
SJ
Department of Physical Medicine and Rehabilitation, Federal University of São Paulo, São Paulo, SP, Brazil.
Chamlian
Therezinha Rosane
TR
de Souza
José Marconi
JM
Stefanini
Edson
E
Azevedo
Rudyney
R
Mussi
Aurélia
A
Carvalho
Antonio Carlos
AC
D054058:Acute Coronary Syndrome / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000674:Amputees; D050197:Atherosclerosis / Q000453:epidemiology; D015897:Comorbidity; D003925:Diabetic Angiopathies / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D016491:Peripheral Vascular Diseases / Q000453:epidemiology*; D015995:Prevalence; D011877:Radionuclide Imaging; D013927:Thrombosis / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult