Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography.
Am Heart J
; 137(3): 469-75, 1999 Mar.
Article
em En
| MEDLINE
| ID: mdl-10047628
ABSTRACT
BACKGROUND:
Coronary disease is an important cause of long-term morbidity in patients needing major vascular surgery. We sought to assess the efficacy of preoperative clinical evaluation and the detection of inducible ischemia for prediction of immediate and long-term cardiac outcomes of patients undergoing vascular surgery.METHODS:
In 233 patients undergoing vascular procedures, we assessed risk clinically on the basis of Eagle's criteria. Dobutamine echocardiography was performed with a standard protocol and results were classified as showing ischemia, scar, or a normal response. Patients were observed perioperatively, and late follow-up (28 +/- 13 months) was completed in all surgical survivors. A composite end point of cardiac death, myocardial infarction, and unstable and progressive angina requiring late revascularization was used to judge event-free survival.RESULTS:
Of 233 patients undergoing preoperative dobutamine echocardiography, 39 (17%) had inducible ischemia and 36 (15%) had scar. Perioperative events occurred in 8 patients (3%). None of the patients with ischemia had perioperative events, reflecting the effect of revascularization in 9 patients. Late events occurred in 36 patients; ischemia on preoperative stress testing was a predictor of these events even after adjusting for clinical variables and left ventricular dysfunction (relative risk = 3.3; 95% confidence interval 1.6 to 6.8; P =.001). The association of ischemia with clinical predictors was associated with incrementally worse outcome.CONCLUSION:
In addition to perioperative assessment, the combined use of clinical and dobutamine echocardiographic evaluation may stratify the risk of late cardiac events.
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Base de dados:
MEDLINE
Assunto principal:
Procedimentos Cirúrgicos Vasculares
/
Ecocardiografia
/
Agonistas Adrenérgicos beta
/
Doença das Coronárias
/
Dobutamina
Idioma:
En
Ano de publicação:
1999
Tipo de documento:
Article