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Italian Journal of Vascular and Endovascular Surgery 2004 June;11(2):73-82

Copyright © 2005 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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