Ombrellaro M P, Dieter R A, Freeman M, Stevens S L, Goldman M H
Department of Surgery, University of Tennessee Medical Center, Graduate School of Medicine, Knoxville 37920, USA.
J Am Coll Surg. 1995 Nov;181(5):451-8.
Absence of cardiac symptoms is not a valid indicator of low cardiac risk in the sedentary patient who is being considered for vascular surgery. Invasive methods of cardiac assessment in such patients are associated with risk and are expensive. This study was carried out to evaluate the utility of pre-operative cardiac risk stratification with dipyridamole myocardial scintigraphy (DMS), in patients to undergo carotid artery surgery.
From 1991 to 1994, 174 of 266 carotid endarterectomy patients underwent preoperative DMS. The ability of clinical factors and DMS to predict postoperative cardiac morbidity was assessed retrospectively in a nonrandomized fashion.
Forty-seven adverse cardiac events (deaths = 0, myocardial infarction (MI) = 4, congestive heart failure (CHF) = 9, angina = 7, and new dysrhythmias = 27) occurred in 38 (14.3 percent) of 266 patients. Results of DMS were 73 percent normal, 10.3 percent fixed defect, and 16.7 percent reversible defect examinations. Sensitivity and specificity of DMS was 32 and 74 percent for total cardiac morbidity, and 50 and 74 percent for MI. The positive predictive value of DMS for MI, dysrhythmias, CHF, angina, and all cardiac events was 4, 11, 9, zero, and 23 percent, respectively. Negative predictive values were 98, 91, 98, 95, and 82 percent, respectively. Preoperative histories of MI and chest pain were significant independent predictors of adverse cardiac outcomes (p < 0.05) while age greater than 70 years, smoking, hypertension, diabetes mellitus, preoperative arrhythmias, and DMS were not.
Dipyridamole myocardial scintigraphy is an ineffective predictor of adverse cardiac events in patients being evaluated for carotid artery surgery and its routine use is not justified.
对于正在考虑接受血管手术的久坐不动患者，没有心脏症状并非低心脏风险的有效指标。在此类患者中，侵入性心脏评估方法存在风险且费用高昂。本研究旨在评估双嘧达莫心肌闪烁显像（DMS）在接受颈动脉手术患者术前心脏风险分层中的效用。
1991年至1994年，266例接受颈动脉内膜切除术的患者中有174例接受了术前DMS检查。以非随机方式回顾性评估临床因素和DMS预测术后心脏并发症的能力。
266例患者中有38例（14.3%）发生了47例不良心脏事件（死亡0例，心肌梗死（MI）4例，充血性心力衰竭（CHF）9例，心绞痛7例，新发心律失常27例）。DMS检查结果为73%正常，10.3%为固定缺损，16.7%为可逆缺损。DMS对总体心脏并发症的敏感性和特异性分别为32%和74%，对MI的敏感性和特异性分别为50%和74%。DMS对MI、心律失常、CHF、心绞痛和所有心脏事件的阳性预测值分别为4%、11%、9%、0%和23%。阴性预测值分别为98%、91%、98%、95%和82%。术前MI和胸痛病史是不良心脏结局的显著独立预测因素（p<0.05），而年龄大于70岁、吸烟、高血压、糖尿病、术前心律失常和DMS则不是。
双嘧达莫心肌闪烁显像在评估颈动脉手术患者不良心脏事件方面是一种无效的预测指标，其常规使用不合理。
