Coley C M, Field T S, Abraham S A, Boucher C A, Eagle K A
Department of Medicine, Massachusetts General Hospital, Boston 02114.
Am J Cardiol. 1992 May 15;69(16):1280-5. doi: 10.1016/0002-9149(92)91221-o.
The ability to stratify cardiac risk before nonvascular surgery using clinical markers and dipyridamole-thallium scanning (DTS) was assessed for patients with known or suspected coronary artery disease unable to exercise. Of 100 consecutively studied patients who proceeded to nonvascular surgery, 9 (9%) experienced greater than or equal to 1 perioperative cardiac ischemic event, including death in 2 patients (2%) and nonfatal myocardial infarction in 2 (2%). Logistic regression identified 2 clinical predictors (age greater than 70 years and history of heart failure), and 1 DTS (thallium redistribution) predictor of events. Of 45 patients with neither clinical variable, none (0%; 95% confidence intervals [CI] 0 to 8%) had events. Of 55 patients with greater than or equal to 1 clinical marker, 9 (16.4%; 95% CI 7 to 26%) had events. Within this subgroup, 1 of 31 patients (3.2%; 95% CI 0 to 16%) without thallium redistribution had events compared with 8 of 24 (33.3%; 95% CI 14 to 52%) with redistribution. An algorithm combining 5 independent clinical and 2 DTS predictors, derived previously in vascular surgery patients, was validated in the 100 nonvascular surgery patients. It is concluded that preoperative planar DTS is most useful to stratify selected nonvascular surgery patients at intermediate or high risk by clinical assessment. However, for almost half of those patients with known or suspected coronary artery disease, DTS may be unnecessary because of sufficiently low predictive value based on simple clinical descriptors.
对于已知或疑似患有冠状动脉疾病且无法进行运动的患者，评估了使用临床指标和双嘧达莫-铊扫描（DTS）在非血管手术前对心脏风险进行分层的能力。在连续接受研究并进行非血管手术的100例患者中，9例（9%）发生了≥1次围手术期心脏缺血事件，包括2例患者死亡（2%）和2例非致命性心肌梗死（2%）。逻辑回归确定了2个临床预测因素（年龄大于70岁和心力衰竭病史）以及1个DTS（铊再分布）事件预测因素。在45例无临床变量的患者中，无一例（0%；95%置信区间[CI]为0至8%）发生事件。在55例有≥1个临床指标的患者中，9例（16.4%；95%CI为7至26%）发生了事件。在该亚组中，31例无铊再分布的患者中有1例（3.2%；95%CI为0至16%）发生了事件，而24例有铊再分布的患者中有8例（33.3%；95%CI为14至52%）发生了事件。一种结合了5个独立临床因素和2个DTS预测因素的算法，先前在血管手术患者中得出，在这100例非血管手术患者中得到了验证。得出的结论是，术前平面DTS对于通过临床评估对选定的中、高危非血管手术患者进行风险分层最为有用。然而，对于近一半已知或疑似患有冠状动脉疾病的患者，由于基于简单临床描述的预测价值足够低，DTS可能不必要。
