Multivariate clinical models and quantitative dipyridamole-thallium imaging to predict cardiac morbidity and death after vascular reconstruction

Journal Article · Thu Aug 01 00:00:00 EDT 1991 · Journal of Vascular Surgery; (United States)

DOI:https://doi.org/10.1067/mva.1991.28565· OSTI ID:5265598

Lette, J; Waters, D; Lassonde, J; Rene, P; Picard, M; Laurendeau, F; Levy, R; Cerino, M; Nattel, S ^[1]

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1. Maisonneuve Hospital Centre, Montreal, Quebec (Canada)

Patients with peripheral vascular disease have a high prevalence of coronary artery disease and are at increased risk for cardiac morbidity and death after vascular reconstruction. The present study was undertaken to assess the value of 18 clinical parameters, of 7 clinical scoring systems, and of quantitative dipyridamole-thallium imaging for predicting the occurrence of postoperative myocardial infarction or cardiac death. Vascular surgery was performed in 125 patients. Thirteen postoperative cardiac events occurred, including 10 cardiac deaths and 3 nonfatal infarctions. Clinical parameters were not useful in predicting postoperative outcome. All 63 patients with normal scan results or fixed perfusion defects underwent surgery uneventfully, whereas 21% (13/62) of patients with reversible defects had a postoperative cardiac complication. By use of quantitative scintigraphic indexes we found that patients with reversible defects could be stratified into intermediate and high-risk subgroups with postoperative event rates of 5% (2/47) and 85% (11/13), respectively, despite intensive postoperative monitoring and antianginal medication. Thus in patients unable to complete a standard exercise stress test, postoperative outcome cannot be predicted clinically, whereas dipyridamole-thallium imaging successfully identified all patients who had a postoperative cardiac event. By use of quantification we found that patients with reversible defects can be stratified into an intermediate risk subgroup that can undergo surgery with minimal complication rate and a high-risk subgroup that requires coronary angiography.

• OSTI ID: 5265598
• Journal Information: Journal of Vascular Surgery; (United States), Vol. 14:2; ISSN 0741-5214
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BLOOD VESSELS
SURGERY
HEART
RADIOISOTOPE SCANNING
MYOCARDIAL INFARCTION
FORECASTING
CANADA
MORTALITY
MULTIVARIATE ANALYSIS
PATIENTS
RISK ASSESSMENT
THALLIUM ISOTOPES
VASCULAR DISEASES
VASODILATORS
BODY
CARDIOVASCULAR AGENTS
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
COUNTING TECHNIQUES
DEVELOPED COUNTRIES
DISEASES
DRUGS
ISOTOPES
MATHEMATICS
MEDICINE
NORTH AMERICA
ORGANS
STATISTICS
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