Landesberg Giora, Mosseri Morris, Wolf Yehuda G, Bocher Moshe, Basevitch Alon, Rudis Ehud, Izhar Uzi, Anner Haim, Weissman Charles, Berlatzky Yacov
Department of Anesthesiology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
Circulation. 2003 Jul 15;108(2):177-83. doi: 10.1161/01.CIR.0000080292.11186.FB. Epub 2003 Jun 30.
Ischemia on thallium scanning is a strong predictor of long-term mortality in CAD patients. Whether coronary revascularization (CR) in patients with significant ischemia on preoperative thallium scanning (PTS) improves long-term survival after major vascular surgery has not been determined.
The perioperative data, including PTS and subsequent CR in patients with moderate to severe reversible ischemia on PTS, and long-term survival of 502 consecutive patients who underwent 578 major vascular procedures were analyzed retrospectively. Patients with PTS who ultimately did not undergo the planned vascular operation were also studied. Cox regression and propensity score analyses were used to analyze survival. A total of 407 patients (81.1%) had PTS: 221 (54.3%) had no or mild defects (group I); 50 (12.3%) had moderate-severe fixed defects (group II); 62 (15.2%) had moderate-severe reversible ischemia yet did not undergo CR (group III); and 74 (18.2%) had moderate-severe reversible ischemia and subsequent CR by CABG (36) or PTCA (38; group IV). Patients who sustained major complications as a result of the preoperative cardiac workup were included in group IV. By multivariate analysis, age, type of vascular surgery, presence of diabetes, previous myocardial infarction, and moderate-severe ischemia on PTS independently predicted mortality (P=0.001, 0.009, 0.039, 0.006, and 0.029, respectively), and preoperative CR predicted improved survival (OR 0.52, P=0.018). Group IV had better survival than group III even when subdivided according to normal and reduced left ventricular function (OR 0.40 and 0.41, P=0.035 and 0.021, respectively).
Long-term survival after major vascular surgery is significantly improved if patients with moderate-severe ischemia on PTS undergo selective CR.
铊扫描显示的心肌缺血是冠心病患者长期死亡率的有力预测指标。术前铊扫描（PTS）显示有明显缺血的患者进行冠状动脉血运重建（CR）是否能改善大血管手术后的长期生存率尚未确定。
回顾性分析了502例连续接受578例大血管手术患者的围手术期数据，包括PTS以及PTS显示中度至重度可逆性缺血患者随后的CR情况，以及长期生存率。还研究了最终未进行计划血管手术的PTS患者。采用Cox回归和倾向评分分析来分析生存率。共有407例患者（81.1%）进行了PTS：221例（54.3%）无或有轻度缺损（I组）；50例（12.3%）有中度至重度固定缺损（II组）；62例（15.2%）有中度至重度可逆性缺血但未进行CR（III组）；74例（18.2%）有中度至重度可逆性缺血且随后通过冠状动脉旁路移植术（CABG，36例）或经皮冠状动脉腔内血管成形术（PTCA，38例）进行了CR（IV组）。因术前心脏检查出现严重并发症的患者纳入IV组。多因素分析显示，年龄、血管手术类型、糖尿病的存在、既往心肌梗死以及PTS显示的中度至重度缺血独立预测死亡率（分别为P = 0.001、0.009、0.039、0.006和0.029），术前CR预测生存率提高（OR 0.52，P = 0.018）。即使根据左心室功能正常和降低进行细分，IV组的生存率也高于III组（OR分别为0.40和0.41，P = 0.035和0.021）。
PTS显示中度至重度缺血的患者进行选择性CR可显著提高大血管手术后的长期生存率。
