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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2004 June;11(2):73-82
Limitations of cardiac risk stratification in vascular surgery. Results of a prospective study
Rumolo A. 1, Gargiulo M. 1, Polverini I. 1, Barbieri A. 2, Bursi F. 2, Lonardi R. 1, Corradi R. 1, Modena M. G. 2, Stella A. 1
1 Vascular Surgery Unit University of Modena and Reggio Emilia, Modena, Italy
2 Cardiology Unit University of Modena and Reggio Emilia, Modena, Italy
Aim. The study evaluated the efficacy of the American College of Cardiology (ACC) and the American Heart Association (AHA) model for cardiac risk stratification originally published in 1996, then revised in 2002.
Methods. From September 1, 2000 to September 30, 2001 a total of 440 consecutive patients (304 men and 136 women; age range, 25-91 years) received elective vascular surgery at our department. All patients were assessed by preoperative cardiac risk stratification following the ACC/AHA guidelines. Only 228 of 440 patients underwent high and intermediate risk surgery; in 6 myocardial revascularization was performed before vascular surgery, according to AHA/ACC guidelines. Major arrhythmias, new episodes of myocardial ischemia, acute myocardial infarction, heart failure and cardiac death in the immediate and early postoperative period were defined as cardiac events. Results of 12-lead ECG, serum CPK-MB and troponin I dosing were taken as indicators of myocardial negative events.
Results. No cardiac events occurred in the 129 carotid surgery patients, 3 cardiac events (6.5%) and 1 death (2.2%) occurred in the aortoiliac surgery patients; 5 out of 113 (4.4%) patients treated for femoro-distal disease experienced a cardiac event, one of whom (0.9%) died of cardiac causes. No cardiac events occurred in patients who received preoperative myocardial revascularization.
Conclusion. Cardiac risk stratification following the ACC/AHA guidelines was found to be a useful procedure that reduces preoperative cardiac tests in low-risk patients and identifies those patients that need myocardial revascularization before vascular surgery. The probability of a cardiac event is low in carotid surgery, but it remains high in aortic surgery, particularly peripheral surgery.