Introduction; While cardiac complications are an important cause of morbidity and mortality in major elective vascular surgery, the value of prophylactic coronary revascularization (PCR) is unclear. Methods and Patients: Retrospective study of 443 consecutive patients admitted for elective vascular surgery at UCDMC between 12/89 and 3/95. Pic-operative caithac evaluation: 264 dipyridamole-thaUium imaging [DTTJ, 5 treadmill tests, 6 dobutamine echogram, 33 patients went directly to cardiac catbeterization (CATH). 136 patients went directly to vascular surgery, including 21 who had coronary bypass surgery (CABG) within a year prior to admission. 7 patients had surgery cancelled, 2 died from myocardial infarction (MI) before surgery. 434 patients underwent vascular surgery were our study group. Perioperative cardiac events, defined as death, MI, congestive heart failure (CHF), unstable angina, and major complications from CATH/PTCA/CABG were examined. The total events in patients with PCR woe compared to the cardiac events in patients without PCR, matched for the number of clinical risks, those with a DTI abnormality were matched separately. Results; Clinical risks that have significant association with perioperative cardiac complication, identified by univariate and logistic regression analysis include history of CHF (relative risk [RR] 2.14), age 70 years or older (RR=2.22), angina (RR.1.81), history of Ml/CAD/Q wave/bundle branch block (RR=2.02), chronic renal insufficiency (RR=1.68), and a DTI abnormality (RR=6.42). Ill CATH were performed, leading to 12 PTCA and 26 CABG. 5 major complications from these procedures. There were 41 perioperative cardiac events, including 14 deaths. The perioperative cardiac event rate did not differ in the 59 patients with PCR or CABG within 1 year before vascular surgery (7/59, 11.9%) compared to patients without PCR (34/37, 9.1%). Cardiac event rate of patients with vs. without PCR,matched by the number of clinical risk (CR): no CR- 0.0 vs. 3.4; 1 CR0.0 vs. 6.5; 2 CR- 22.2 vs. 12.4; 3 or more CR-18.8 vs. 24.4; patients with DTI abnormality: 11.8 vs. 18.7. When complications from PCR were included in the analysis: no CR- 0.0 vs. 3.4; 1 CR- 9.5 vs. 6.5; 2 CR- 22.2 vs. 12.4; 3 or more CR- 31.2 vs. 24.4; patients with DT1 abnormality: 20.6 vs. 19.4. Conclusion: Prophylactic coronary revascularization before major elective vascular surgery may not lead to better short term outcome.
|Original language||English (US)|
|Journal||Journal of Investigative Medicine|
|State||Published - 1996|
ASJC Scopus subject areas
- Biochemistry, Genetics and Molecular Biology(all)