Kim Tae-Yoon, Yun Woo-Sung, Park Kihyuk
Division of Vascular/Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea.
J Korean Surg Soc. 2013 Mar;84(3):178-84. doi: 10.4174/jkss.2013.84.3.178. Epub 2013 Feb 27.
To identify the risk factors of major adverse cardiac event (MACE) in patients with chronic atherosclerotic lower extremity ischemia (CALEI) undergoing revascularization without noninvasive stress testing (NIST).
From January 2007 to January 2012, patients with CALEI who underwent revascularization were retrospectively reviewed. Emergent operations, revision procedures for previous surgery, or patients with active cardiac conditions were excluded. NIST was not performed for patients without active cardiac conditions. Cardiac risk was categorized into low, intermediate and high risk, according to the Lee's revised cardiac risk index. MACE was defined as acute myocardial infarction or any cardiac death within 30 days after surgery.
A total of 459 patients underwent elective lower extremity revascularization procedures (240 open surgeries, 128 endovascular procedures, and 91 hybrid surgeries). The treated lesions comprised of 18% aorto-iliac, 58% infrainguinal, and 24% combined lesions. With regard to cardiac risk, low-, intermediate- and high risks were 67%, 32% and 2%, respectively. MACE was developed in 7 patients (2%). High or intermediate risk group by the Lee's index was related to postoperative MACE. Subgroup analysis for open surgery or hybrid surgery group identified female gender as an independent risk factor of MACE (P = 0.049; odds ratio, 5.168; confidence interval, 1.011 to 26.423).
The Lee's index was a useful predictor of MACE. MACE is more common in female patients than male patients after open or hybrid surgery. Routine preoperative NIST is not suggested for all patients undergoing revascularization for CALEI, especially for those in the low risk group.
确定在未进行无创应激试验（NIST）的情况下接受血运重建的慢性动脉粥样硬化性下肢缺血（CALEI）患者发生主要不良心脏事件（MACE）的风险因素。
回顾性分析2007年1月至2012年1月期间接受血运重建的CALEI患者。排除急诊手术、既往手术的翻修手术或有活动性心脏疾病的患者。对于无活动性心脏疾病的患者未进行NIST。根据Lee修订的心脏风险指数，将心脏风险分为低、中、高风险。MACE定义为术后30天内发生的急性心肌梗死或任何心脏死亡。
共有459例患者接受了择期下肢血运重建手术（240例开放手术、128例血管内手术和91例杂交手术）。治疗的病变包括18%的主-髂动脉病变、58%的腹股沟下病变和24%的联合病变。关于心脏风险，低、中、高风险分别为67%、32%和2%。7例患者（2%）发生了MACE。Lee指数的高或中风险组与术后MACE相关。开放手术或杂交手术组的亚组分析确定女性性别是MACE的独立风险因素（P = 0.049；比值比，5.168；置信区间，1.011至26.423）。
Lee指数是MACE有用的预测指标。开放或杂交手术后，女性患者发生MACE比男性患者更常见。不建议对所有接受CALEI血运重建的患者进行常规术前NIST，尤其是低风险组的患者。
