Preoperative assessment of cardiac risk in noncardiac major vascular surgery

Roghi, Alberto; Palmieri, Bruno; Crivellaro, Wilma; Sara, Roberto; Puttini, M; Faletra, Francesco F.

doi:10.1016/s0002-9149(98)00819-4

Cited by 22 publications

(10 citation statements)

References 29 publications

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“…Baron et al reported mortality of 4.4% and morbidity of 19% in 457 patients who underwent conventional abdominal aortic surgery, 29 and Roghi et al reported mortality and morbidity of 1.5% and 10.4%, respectively, in 320 patients including 119 open aortic procedures. 30 These incidences of adverse clinical outcomes are higher than the results of our study, caused in part by the invasiveness of the procedure used in each of those studies. In addition, myocardial perfusion imaging was qualitatively assessed for the presence or absence of perfusion defects, 29,30 whereas we used a 20-segment SPECT model to evaluate the extent and severity of coronary artery disease.…”

Section: Discussioncontrasting

confidence: 63%

“…30 These incidences of adverse clinical outcomes are higher than the results of our study, caused in part by the invasiveness of the procedure used in each of those studies. In addition, myocardial perfusion imaging was qualitatively assessed for the presence or absence of perfusion defects, 29,30 whereas we used a 20-segment SPECT model to evaluate the extent and severity of coronary artery disease. [21][22][23] Although the presence of extensive reversible defects is important for identifying high-risk patients who require preoperative coronary revascularization, we found that the best predictor for perioperative cardiac events was the model-derived SSS.…”

Section: Discussioncontrasting

confidence: 63%

“…29,30 The patient population in both these studies was younger (63-66 years) than in ours (71 years). Baron et al reported mortality of 4.4% and morbidity of 19% in 457 patients who underwent conventional abdominal aortic surgery, 29 and Roghi et al reported mortality and morbidity of 1.5% and 10.4%, respectively, in 320 patients including 119 open aortic procedures.…”

Section: Discussionmentioning

confidence: 54%

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Value of Pharmacologic Stress Myocardial Perfusion Imaging for Preoperative Risk Stratification for Aortic Surgery

Harafuji

Chikamori

Kawaguchi

et al. 2005

Circ J

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valuating the risk of perioperative cardiac events related to noncardiac surgery is important. [1][2][3][4][5][6][7][8][9] Preoperative myocardial perfusion imaging is useful for further stratification of the risk in moderate-and highrisk patients 3,4 because the redistribution findings can be used as predictive factors for cardiac events, and the technique has a high negative predictive value. [5][6][7][8] Moreover, recent studies suggest that the likelihood of cardiac events increases with the severity of the defect score on images evaluated semi-quantitatively 4,6-9 and guidelines for the perioperative cardiovascular evaluation of noncardiac surgery patients were recently published by the ACC/AHA, providing a framework for weighting the cardiac risk of noncardiac surgery based on patients' risk profiles and the type of operation. 10 Of the procedures, aortic surgery is claimed to be high-risk (the reported cardiac risk is often ≥5%), not only because it is highly invasiveness surgery but also because of the high prevalence of coronary artery disease in patients with aortic diseases. 10-12 However, there are few studies regarding preoperative risk stratification in Japanese patients who undergo aortic surgery. 13,14 Thus, the present study evaluated whether perioperative cardiac events related to aortic surgery can be predicted by preoperative pharmacologic stress myocardial perfusion imaging. Methods SubjectsThe subjects of this study were 302 consecutive patients who underwent elective aortic surgery after pharmacologic stress single-photon emission computed tomography (SPECT) between January 1998 and August 2003. SPECT study was performed in all patients unless contraindications such as bronchial asthma and advanced heart block were present. There were 261 men and 41 women, aged 71±10 years (35-86 years); 128 of them (42%) were aged 75 years or older. Medical history of angina pectoris was noted in 19 patients, myocardial infarction (MI) in 26, and heart failure in 5; 19 of them had undergone coronary revascularization. Hypertension was found in 217 patients, hypercholesterolemia in 73, diabetes mellitus (DM) in 55, and renal insufficiency defined as serum creatinine level ≥2.0 mg/dl in 20.The etiologies of the aortic diseases were type B aortic dissection in 56 patients, thoracic aortic aneurysm in 124, and abdominal aortic aneurysm in 122. The indication for aortic surgery was decided by cardiovascular surgeons based on the anatomical and pathological indications. [15][16][17][18] The type of surgery was conventional open surgery in 75 patients and endovascular surgery with stent -graft placement in 227. Aortic surgery including stent -graft placement was performed under general anesthesia. Approval to perform the endovascular surgery was obtained from the Ethical Committee of Tokyo Medical University. Written informed consent was obtained from all of the patients. Stress Myocardial ScintigraphyPharmacologic stress SPECT was performed ≥15 h after Background Aortic surgery is an invasive, high-risk noncard...

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Section: Discussioncontrasting

confidence: 63%

Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 54%

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Value of Pharmacologic Stress Myocardial Perfusion Imaging for Preoperative Risk Stratification for Aortic Surgery

Harafuji

Chikamori

Kawaguchi

et al. 2005

Circ J

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“…Using this ACC/AHA guideline-influenced approach, the overall cardiac mortality for the cohort was only 1%, and there were no significant differences in outcome among patients with low, intermediate, or high clinical risk. Another report 231 also used the clinical risk factor parameters to divide vascular surgery patients into low-, intermediate-, and high-cardiac-risk groups. Those authors did not include functional capacity measurements but noted a 0% death or MI rate in the perioperative period among the low-risk patients.…”

Section: Fleisher Et Al Acc/aha 2007 Perioperative Guidelines E441mentioning

confidence: 99%

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

Fleisher¹,

Beckman²,

Brown³

et al. 2007

Circulation

626

281

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“…Therefore, preoperative risk stratifi cation for possible cardiac events is very important, as well as the follow-up of postoperative patients. In the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, noninvasive testing is useful for preoperative risk stratifi cation for high-risk surgical procedures [1], and many articles have discussed the usefulness of myocardial perfusion single photon emission computed tomography (SPECT) for preoperative risk stratifi cation of noncardiac surgery [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Most of these studies concluded that myocardial perfusion SPECT was predictive of perioperative cardiac events of noncardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Gated myocardial perfusion SPECT for preoperative risk stratification in patients with noncardiac vascular disease

et al. 2009

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Preoperative assessment of cardiac risk in noncardiac major vascular surgery

Cited by 22 publications

References 29 publications

Value of Pharmacologic Stress Myocardial Perfusion Imaging for Preoperative Risk Stratification for Aortic Surgery

Value of Pharmacologic Stress Myocardial Perfusion Imaging for Preoperative Risk Stratification for Aortic Surgery

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

Gated myocardial perfusion SPECT for preoperative risk stratification in patients with noncardiac vascular disease

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