术前双嘧达莫-铊扫描、选择性冠状动脉血运重建与严重下肢缺血患者的长期生存

Preoperative dipyridamole-thallium scanning, selective coronary revascularization and long-term survival in patients with critical lower limb ischemia.

作者信息

Wolf Y G, Landersberg G, Mosseri M, Schechter D, Anner H, Weissman C, Berlatzky Y

机构信息

Department of Vascular Surgery, University Hospital, Jerusalem, Israel.

出版信息

J Cardiovasc Surg (Torino). 2001 Feb;42(1):89-95.

PMID:11292913

Abstract

BACKGROUND

A large proportion of patients with critical limb ischemia have advanced, often asymptomatic coronary artery disease which is associated with increased perioperative risk and decreased long-term survival.

METHODS

We evaluated retrospectively the short and long-term effect of routine dipyridamole-thallium cardiac scanning (DTS) and selective coronary revascularization in 113 consecutive patients who were scheduled for revascularization of the lower extremity.

RESULTS

DTS was abnormal in 60 (53.1%) patients and demonstrated a moderate-severe reversible defect in 26 (23.0%) patients. On the basis of DTS and clinical evaluation 33 (29.2%) patients were referred for coronary catheterization. Of these, 9 underwent PTCA and 4 underwent coronary artery bypass, without complications. Surgical revascularization of the limbs was performed in all but two patients. Two (1.8%) patients died postoperatively, three (2.7%) sustained nonfatal postoperative myocardial infarctions. None of the patients who underwent preoperative coronary revascularization suffered a cardiac complication after the peripheral vascular operation. During mean follow-up of 31.7 months, 30 (28.0%) patients died. A moderate-severe reversible defect on DTS was the strongest predictor for shortened survival (Exp(b)=0.61, CI 95%=0.42-0.88; p=0.006). Patients who underwent preoperative coronary revascularization followed a survival curve approaching those without a reversible defect on DTS (mean survival 61+/-8 vs 63+/-4 months; NS) which was significantly better than those with such a defect who did not undergo coronary revascularization (mean survival 34+/-5 months; p=0.03).

CONCLUSIONS

While the perioperative benefits of routine preoperative DTS screening in patients with critical limb ischemia, remain debatable, it provides an opportunity for identification and treatment of life-limiting coronary artery disease and improving survival.

摘要

背景

大部分严重肢体缺血患者患有进展性、通常无症状的冠状动脉疾病，这与围手术期风险增加及长期生存率降低相关。

方法

我们回顾性评估了113例计划接受下肢血运重建术的连续患者常规双嘧达莫 - 铊心肌扫描（DTS）及选择性冠状动脉血运重建的短期和长期效果。

结果

60例（53.1%）患者DTS异常，26例（23.0%）患者显示中重度可逆性缺损。基于DTS和临床评估，33例（29.2%）患者被转诊进行冠状动脉造影。其中，9例接受了经皮冠状动脉腔内血管成形术（PTCA），4例接受了冠状动脉搭桥术，均无并发症。除2例患者外，所有患者均进行了肢体手术血运重建。2例（1.8%）患者术后死亡，3例（2.7%）发生非致命性术后心肌梗死。术前接受冠状动脉血运重建的患者在周围血管手术后均未发生心脏并发症。在平均31.7个月的随访期间，30例（28.0%）患者死亡。DTS上的中重度可逆性缺损是生存缩短的最强预测因素（Exp(b)=0.61，95%可信区间=0.42 - 0.88；p=0.006）。术前接受冠状动脉血运重建的患者的生存曲线接近DTS上无可逆性缺损的患者（平均生存61±8个月对63±4个月；无显著性差异），明显优于有此类缺损但未接受冠状动脉血运重建的患者（平均生存34±5个月；p=0.03）。