A clinical survival score predicts the likelihood to benefit from preoperative thallium scanning and coronary revascularization before major vascular surgery
| Autor: | Tatyana Ganon-Rozental, Charles Weissman, Ron Alcalai, Morris Mosseri, Inna Akopnik, Yacov Berlatzky, Moshe Bocher, Myron H. Luria, Haim Anner, Giora Landesberg |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Ischemia Scintigraphy Risk Assessment Preoperative care Postoperative Complications Internal medicine Angioplasty Diabetes mellitus Preoperative Care Myocardial Revascularization medicine Humans Vascular Diseases Angioplasty Balloon Coronary Survival analysis Aged Retrospective Studies Tomography Emission-Computed Single-Photon medicine.diagnostic_test business.industry Retrospective cohort study Length of Stay Vascular surgery medicine.disease Survival Analysis Thallium Radioisotopes Heart failure Cardiology Female Stents Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal. 28:533-539 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehl390 |
| Popis: | Aims Guidelines advocate selective non-invasive testing before major non-cardiac surgery, yet data defining who may benefit from such tests is lacking. We aimed to find the predictors that define patients who are most likely to benefit from preoperative cardiac testing and coronary revascularization (CR). Methods and results In 624 consecutive major vascular surgery patients, the preoperative thallium scanning (PTS) results and subsequent CRs were correlated with long-term (3–15 years) survival. Of all patients, 510 (80.6%) had PTS, 154 (24.7%) had moderate-severe ischaemia on PTS, and 96 (15.4%) underwent CR. Seven predictors: age ≥65, diabetes, cerebrovascular disease, ischaemic heart disease, congestive heart failure, ST-depression on preoperative ECG, and renal insufficiency, independently determined long-term survival. A long-term survival score (LTSS) comprised of these predictors, divided all patients into low, intermediate, and high-risk groups (0–1, 2–3, ≥4 predictors, respectively) with a 5-year survival of 83 ± 2%, 60 ± 3%, and 34 ± 6%, respectively. Compared with low-risk patients, intermediate and high-risk patients had worse survival [HR (CI) = 2.6 (2.0–3.4) and 5.9 (4.1–8.9), respectively, P < 0.001]. Yet, only the intermediate-risk group had better long-term survival following preoperative CR [HR = 0.48 (0.31–0.75), P = 0.001]. The low-risk groups' favourable survival and high-risk groups' poor survival were not significantly affected by CR. Conclusion Intermediate-risk patients (LTSS 2–3) are most likely to have a long-term survival benefit from PTS and CR. |
| Databáze: | OpenAIRE |
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