Cutler B S, Hendel R C, Leppo J A
Division of Vascular Surgery, University of Massachusetts Medical School, Worcester 01655.
J Vasc Surg. 1992 Jun;15(6):972-9; discussion 980-1.
The purpose of this study was to evaluate the ability of dipyridamole-thallium scintigraphy to predict perioperative and late cardiac events after peripheral vascular operations. A total of 262 patients had dipyridamole-thallium scintigraphy before 87 infrainguinal reconstructions, 108 abdominal aortic aneurysm operations, and 67 aortobifemoral bypass grafts that were placed for occlusive disease. Follow-up extended to 5 years (mean, 31.1 months). Logistic regression analysis selected dipyridamole-thallium scintigraphy redistribution as the best predictor of perioperative events. Fixed defects were not predictive. A Cox proportional hazards model for a variety of clinical risk factors and scan parameters identified fixed defects and a history of congestive heart failure as the strongest predictors of late cardiac events. The presence of greater than 1 or 2 fixed segments were the best predictors in patients with an abnormal scan; redistribution did not predict late events. The risk of combined perioperative or late cardiac events was 29% for infrainguinal, 19% for abdominal aortic aneurysm, and 7.5% for aortobifemoral operations. Life-table analysis showed that after a cluster of perioperative events that occurred primarily in patients with dipyridamole-thallium scintigraphy redistribution, most of the late cardiac morbidity and deaths occurred in patients with fixed defects.
本研究的目的是评估双嘧达莫 - 铊闪烁扫描预测周围血管手术后围手术期及晚期心脏事件的能力。共有262例患者在87例腹股沟下血管重建、108例腹主动脉瘤手术以及67例因闭塞性疾病而行的主 - 双股动脉搭桥手术前接受了双嘧达莫 - 铊闪烁扫描。随访期延长至5年（平均31.1个月）。逻辑回归分析选择双嘧达莫 - 铊闪烁扫描再分布作为围手术期事件的最佳预测指标。固定缺损无预测价值。针对多种临床危险因素和扫描参数的Cox比例风险模型确定固定缺损和充血性心力衰竭病史是晚期心脏事件的最强预测指标。在扫描异常的患者中，出现超过1个或2个固定节段是最佳预测指标；再分布不能预测晚期事件。腹股沟下手术围手术期或晚期心脏事件的合并风险为29%，腹主动脉瘤手术为19%，主 - 双股动脉手术为7.5%。生存表分析显示，在主要发生于双嘧达莫 - 铊闪烁扫描再分布患者的一组围手术期事件之后，大多数晚期心脏发病和死亡发生在有固定缺损的患者中。
