Zellner J L, Elliott B M, Robison J G, Hendrix G H, Spicer K M
Department of Surgery, Medical University of South Carolina, Charleston 29425.
Ann Vasc Surg. 1990 May;4(3):238-43. doi: 10.1007/BF02009451.
Coronary artery disease is frequently present in patients undergoing evaluation for reconstructive peripheral vascular surgery. Dobutamine-thallium imaging has been shown to be a reliable and sensitive noninvasive method for the detection of significant coronary artery disease. Eighty-seven candidates for vascular reconstruction underwent dobutamine-thallium imaging. Forty-eight patients had an abnormal dobutamine-thallium scan. Twenty-two patients had infarct only, while 26 had reversible ischemia demonstrated on dobutamine-thallium imaging. Fourteen of 26 patients with reversible ischemia underwent cardiac catheterization and 11 showed significant coronary artery disease. Seven patients underwent preoperative coronary bypass grafting or angioplasty. There were no postoperative myocardial events in this group. Three patients were denied surgery on the basis of unreconstructible coronary artery disease, and one patient refused further intervention. Ten patients with reversible myocardial ischemia on dobutamine-thallium imaging underwent vascular surgical reconstruction without coronary revascularization and suffered a 40% incidence of postoperative myocardial ischemic events. Five patients were denied surgery because of presumed significant coronary artery disease on the basis of the dobutamine-thallium imaging and clinical evaluation alone. Thirty-nine patients with normal dobutamine-thallium scans underwent vascular reconstructive surgery with a 5% incidence of postoperative myocardial ischemia. Dobutamine-thallium imaging is a sensitive and reliable screening method which identifies those patients with coronary artery disease who are at high risk for perioperative myocardial ischemia following peripheral vascular surgery.
在接受重建性外周血管手术评估的患者中，冠状动脉疾病很常见。多巴酚丁胺-铊显像已被证明是检测严重冠状动脉疾病的一种可靠且敏感的非侵入性方法。87名血管重建候选人接受了多巴酚丁胺-铊显像。48例患者多巴酚丁胺-铊扫描异常。22例患者仅有梗死，而26例在多巴酚丁胺-铊显像上显示可逆性缺血。26例可逆性缺血患者中的14例接受了心脏导管检查，其中11例显示有严重冠状动脉疾病。7例患者接受了术前冠状动脉搭桥术或血管成形术。该组无术后心肌事件发生。3例患者因冠状动脉疾病无法重建而被拒绝手术，1例患者拒绝进一步干预。10例多巴酚丁胺-铊显像显示可逆性心肌缺血的患者在未进行冠状动脉血运重建的情况下接受了血管外科重建，术后心肌缺血事件发生率为40%。5例患者仅根据多巴酚丁胺-铊显像和临床评估就因推测有严重冠状动脉疾病而被拒绝手术。39例多巴酚丁胺-铊扫描正常的患者接受了血管重建手术，术后心肌缺血发生率为5%。多巴酚丁胺-铊显像为一种敏感且可靠的筛查方法，可识别那些在接受外周血管手术后有围手术期心肌缺血高风险的冠状动脉疾病患者。
